Deep Venous Thrombosis (DVT) in Trauma: a Literature Review

Low Dose Heparin

First Author	Year	Reference Title	Class	Conclusions
Clagett GP	1988	Prevention of venous thromboembolism in general surgical patients: Results of a meta-analysis. Ann Surg 208:227-40	I	Meta-analysis of various prophylactic methods used to prevent VTE in general surgical patients. LDH decreased DVT from 25.2% to 8.7% and PE from 1.2% to 0.5% (p<0.001) among treated general surgical patients.
Shackford SR	1990	Venous thromboembolism in patients with major trauma. Am J Surg 159: 365-9	III	177 high risk patients who received LDH, SCD, LDH & SCD or no prophylaxis. Non-randomized, uncontrolled study. VTE rate: LDH - 6%; SCD - 6%; SCD & LDH - 9%; no prophylaxis - 4%. There was no difference in VTE rate between groups.
Dennis JW	1993	Efficacy of deep venous thrombosis prophylaxis in trauma patients and identification of high-risk groups. J Trauma 35: 132-9	III	Prospective, nonrandomized study of 395 patients with ISS > 9 who received LDH, SCD, or no prophylaxis. VTE rate: LDH - 3.2%; SCD - 2.7%; no prophylaxis - 8.8%. Sub-group analysis revealed no significant difference in VTE rate between LDH and no prophylaxis. Some randomization problems with study.
Ruiz AJ	1991	Heparin, deep venous thrombosis, and trauma patients. Am J Surg 162:159-62	III	Non-randomized study in which 100 consecutive patients received LDH or no prophylaxis. VTE rate: LDH - 28%; no prophylaxis - 2%. LDH patients were more severely injured and at bed rest for a longer time period.
Knudson MM	1994	Prevention of venous thromboembolism in trauma patients. J Trauma 37:480-7	II	Randomized, prospective study of 251 patients receiving LDH, SCD or no prophylaxis. There was no significant benefit or VTE with prophylaxis. There was no significant benefit on VTE with prophylaxis except in the subgroup of neurotrauma patients in whom SCD seemed to offer protection.
Upchurch GR Jr	1995	Efficacy of subcutaneous heparin in prevention of venous thromboembolic events in trauma patients. Am Surg 61:749-55	III	Meta-analysis on the use of LDH in 1102 trauma patients revealed no significant benefit on VTE rate: LDH - 10%, no prophylaxis - 7% (p=0.771).

Low Dose Heparin

First Author	Year	Reference Title	Class	Conclusions
Geerts WH	1996	A comparison of low-dose heparin and low- molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med 335:701-7	I	Randomized, double-blind, prospective trial in 334 trauma patients of LDH vs LMWH. LMWH significantly decreased DVT rate (31% vs 44% for LDH, p=0.014).
Napolitano LM	1995	Asymptomatic deep venous thrombosis in the trauma patient: Is an aggressive screening protocol justified? J Trauma 39:651-9	III	437 screened for DVT, nonrandomized. VTE rate: LDH - 8.6%, SCD - 11.6%, LDH & SCD - 8.0%, no prophylaxis - 11.9%. No difference in VTE rate between groups.