Venous thromboembolism prophylaxis with low molecular weight heparin versus unfractionated heparin for patients undergoing operative treatment of closed femoral shaft fractures

Danford, Nicholas C.; Mehta, Sanket; Boddapati, Venkat; Hellwinkel, Justin E.; Jobin, Charles M.; Greisberg, Justin

doi:10.1016/j.jcot.2022.101949

Cited by 2 publications

(2 citation statements)

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“…We identified three large retrospective studies published between 2020 and 2022 in addition to a meta-analysis from 2022, which includes four older RCTs and eight retrospective studies. [20][21][22] Gaitanidis et al focus on 93 987 elderly trauma patients aged older than 65 years in a retrospective study from the database of the ACS TQUIP: 72.1% received LMWH and the remainder received unfractionated heparin (UFH). After propensity score matching, LMWH showed significantly lower rates of DVT (1.7 vs. 2.1%), pulmonary embolism (0.6 vs. 1.0%), blood product transfusions (2.8 vs. 3.5%) and surgical procedures (0.7 vs. 0.9%).…”

Section: Rationalementioning

confidence: 99%

Section: Polytrauma Without Neurotraumamentioning

confidence: 99%

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European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

Heim,

Bruder,

Davenport

et al. 2024

European Journal of Anaesthesiology

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Monitoring hypercoagulation in trauma patients RationaleIt is now well recognised that in the acute phase, after major trauma, the coagulation system is dynamic and, particularly in bleeding patients with trauma-induced coagulopathy or severe brain injury, a hypercoagulable phenotype develops universally within 24 to 48 h. 1 Achieving adequate venous thromboembolism prophylaxis (VTEp) in trauma patients remains challenging for several reasons and despite standardised protocols to administer low-molecular-weight heparin (LMWH), up to 18% of critically injured patients will develop deep venous thrombosis (DVT) or pulmonary embolism despite pharmacoprophylaxis. 2 Measuring serum anti-Xa levels has been proposed to help titrate VTEp, with consensus defining prophylactic anti-Xa levels as 0.2 to 0.4 IU ml À1 for peak measurements or 0.1 to 0.2 IU ml À1 for trough levels, with values below this being subprophylactic. 3 Studies have shown that prophylactic anti-Xa levels compared with subprophylactic levels predict the risk of a clinically significant VTE in trauma patients. [4][5][6] Two studies have reported that anti-Xa-guided dosing of LMWH reduces the rate of VTE after trauma compared with a standard fixed dose of enoxaparin. 7,8 However, a more recent large single centre study has failed to show any benefit of anti-Xa guided dosing for VTEp. 9 Weight-adjusted protocols for LMWH are used in published guidelines 10 based on a handful of studies demonstrating improved rates of prophylactic anti-FXa levels and overall lower VTE rates.

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Section: Rationalementioning

confidence: 99%

Section: Polytrauma Without Neurotraumamentioning

confidence: 99%