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

Anticoagulation

First Author	Year	Reference Title	Class	Conclusions
Hull RD	1986	Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis. N Engl J Med 315:1109-14	I	Randomized double-blind study which demonstrated intravenous heparin decreased recurrent thromboembolism from 19.3% to 5.2% (p=0.024).
Barritt DW	1960	Anticoagulant drugs in the treatment of pulmonary embolism: A controlled trial. Lancet 1:1309-12	I	Unique prospective study which showed that in patients with PE, none died when treated with anticoagulants whereas 26% died who received no treatment.
Brathwaite CE	1993	Complications of anticoagulation for pulmonary embolism in low risk trauma patients. Chest 104:718-20	II	Important study showed that, even in low risk trauma patients, anticoagulation carries a significant (32%) bleeding complication rate.
Hyers TM	1989	Antithrombotic therapy for venous thromboembolic disease. Chest 95(S):37S-51S	II	Review article on anticoagulation for thromboembolic disease with an in-depth description of physiology of how anticoagulant drugs work.
Wessler S	1984	Warfarin: From bedside to bench. N Engl J Med 311:645-52	II	Review article of the actions of warfarin and current recommendations.
Coon WW	1969	Assessment of anticoagulant treatment of venous thromboembolism. Ann Surg 170:559-68	III	Initial study showing that anticoagulation with warfarin should be 1.5-2.5 times the baseline value.

Anticoagulation

First Author	Year	Reference Title	Class	Conclusions
Hull R	1982	Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med 307:1676-81	I	Randomized trial which demonstrated less intense warfarin therapy 1.3-15 times baseline is associated with significantly fewer bleeding complications with lower amounts of anticoagulation.
Schulman S	1995	A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. N Engl J Med 332:1661-5	I	Randomized prospective study which demonstrated significantly less recurrent thromboembolism when anticoagulant therapy was extended to six months.
Levine M	1996	A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 334:677-81	I	Randomized prospective study which demonstrated that LMWH administered subcutaneously at home could be safely substituted for IV heparin in-hospital without increasing the incidence of recurrent thromboembolism.
Koopman MM	1996	Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared to subcutaneous low-molecular-weight heparin administered at home. N Engl J Med 334:682-7	I	Ibid. Mean reduction in hospital stay with 67% in the LMWH group.