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VTE Prophylaxis

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Association Between Enoxaparin Dosage Adjusted by Anti-Factor Xa Trough Level and Clinically Evident Venous Thromboembolism After Trauma.
Ko A, Harada MY, Barmparas G, Chung K, Mason R, Yim DA, Dhillon N, Margulies DR, Gewertz BL, Ley EJ.
JAMA Surg. 2016 Nov 1;151(11):1006-1013.

Rationale for inclusion: Trauma patients who received enoxaparin adjusted by anti-Xa trough levels were compared to standard 30mg BID dosing.  Subprophylactic anti-Xa levels and VTE were more common in the standard dosing group.

Citations - 5 (as of July 2017)

Timing of Pharmacologic Venous Thromboembolism Prophylaxis in Severe Traumatic Brain Injury: A Propensity-Matched Cohort Study.
Byrne JP, Mason SA, Gomez D, Hoeft C, Subacius H, Xiong W, Neal M, Pirouzmand F, Nathens AB.
J Am Coll Surg. 2016 Oct;223(4):621-631.e5.

Rationale for inclusion: TQIP patients with severe TBI (GCS≤8) were compared with respect to initiation of VTE prophylaxis before or after 72hrs.  Early VTE prophylaxis was associated with decreased PE, DVT but no increase in late neurosurgical intervention or death.

Citations - 4 (as of July 2017)

The effectiveness of prophylactic inferior vena cava filters in trauma patients: a systematic review and meta-analysis.
Haut ER, Garcia LJ, Shihab HM, Brotman DJ, Stevens KA, Sharma R, Chelladurai Y, Akande TO, Shermock KM, Kebede S, Segal JB, Singh S.
JAMA Surg. 2014 Feb;149(2):194-202.

Rationale for inclusion: The strength of evidence is low but supports the association of IVC filter placement with a lower incidence of PE and fatal PE in trauma patients. Which patients experience benefit enough to outweigh the harms associated with IVC filter placement remains unclear. 

Citations - 67 (as of July 2017)

A randomized, double-blinded, placebo-controlled pilot trial of anticoagulation in low-risk traumatic brain injury: The Delayed Versus Early Enoxaparin Prophylaxis I (DEEP I) study.
Phelan HA, Wolf SE, Norwood SH, Aldy K, Brakenridge SC, Eastman AL, Madden CJ, Nakonezny PA, Yang L, Chason DP, Arbique GM, Berne J, Minei JP.
J Trauma Acute Care Surg. 2012 Dec;73(6):1434-41.

Rationale for inclusion: TBI progression rates after starting enoxaparin in small, stable injuries 24 hours after injury are similar to those of placebo and are subclinical.

Citations - 48 (as of July 2017)

Improved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical decision support tool for prophylaxis for venous thromboembolism in trauma.
Haut ER, Lau BD, Kraenzlin FS, Hobson DB, Kraus PS, Carolan HT, Haider AH, Holzmueller CG, Efron DT, Pronovost PJ, Streiff MB.
Arch Surg. 2012 Oct;147(10):901-7.

Rationale for inclusion: Implementation of a mandatory computerized decision tool improved compliance with VTE prophylaxis guidelines in trauma patients, resulting in lower rate of VTE events in patients who were not ordered appropriate prophylaxis.

Citations - 69 (as of July 2017)

Complications related to inferior vena cava filters: a single-center experience.
Nazzal M, Chan E, Nazzal M, Abbas J, Erikson G, Sediqe S, Gohara S.
Ann Vasc Surg. 2010 May;24(4):480-6.

Rationale for inclusion: Review of complications after IVC filter placement showed that IVCF were placed frequently for prophylaxis in the absence of VTE conditions.

Citations - 74 (as of July 2017)

Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time.
Park MS, Martini WZ, Dubick MA, Salinas J, Butenas S, Kheirabadi BS, Pusateri AE, Vos JA, Guymon CH, Wolf SE, Mann KG, Holcomb JB.
J Trauma. 2009 Aug;67(2):266-75; discussion 275-6.

Rationale for inclusion: Comparison of trauma/burn patients versus healthy controls showed coagulopathy on TEG as well as a higher PE rate.

Citations - 226 (as of July 2017)

Early venous thromboembolism prophylaxis with enoxaparin in patients with blunt traumatic brain injury.
Norwood SH, Berne JD, Rowe SA, Villarreal DH, Ledlie JT.
J Trauma. 2008 Nov;65(5):1021-6; discussion 1026-7.

Rationale for inclusion:  Enoxaparin should be considered as an option for early VTE prophylaxis in selected patients with blunt TBI. 

Citations - 77 (as of July 2017)

Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank.
Knudson MM, Ikossi DG, Khaw L, Morabito D, Speetzen LS.
Ann Surg. 2004 Sep;240(3):490-6; discussion 496-8.

Rationale for inclusion: Identifiable risk factors exist for development if VTE; additionally, many patients had IVC filters placed without risk factors.

Citations - 330 (as of July 2017)

Prospective evaluation of the safety of enoxaparin prophylaxis for venous thromboembolism in patients with intracranial hemorrhagic injuries.
Norwood SH, McAuley CE, Berne JD, Vallina VL, Kerns DB, Grahm TW, Short K, McLarty JW.
Arch Surg. 2002 Jun;137(6):696-701; discussion 701-2.

Rationale for inclusion: Enoxaparin can be safely used for VTE prophylaxis in trauma patients with IHI when started 24 hours after hospital admission or after craniotomy.

Citations - 142 (as of July 2017)

A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma.
Geerts WH, Jay RM, Code KI, Chen E, Szalai JP, Saibil EA, Hamilton PA.
N Engl J Med. 1996 Sep 5;335(10):701-7.

Rationale for inclusion: Low-molecular-weight heparin was more effective than low-dose heparin in preventing venous thromboembolism after major trauma. Both interventions were safe.

Citations - 726 (as of July 2017)

Routine prophylactic vena cava filter insertion in severely injured trauma patients decreases the incidence of pulmonary embolism.
Rogers FB, Shackford SR, Ricci MA, Wilson JT, Parsons S.
J Am Coll Surg. 1995 Jun;180(6):641-7.

Rationale for inclusion: Comparison of patients given IVC filters versus historical controls. Patients were given filters if considered high risk (head injury, spinal cord injury, complex pelvic fracture, hip fracture), and had lower incidence of pulmonary embolus than historical controls.

Citations - 206 (as of July 2017)

Effectiveness of pneumatic leg compression devices for the prevention of thromboembolic disease in orthopaedic trauma patients: a prospective, randomized study of compression alone versus no prophylaxis.
Fisher CG, Blachut PA, Salvian AJ, Meek RN, O'Brien PJ.
J Orthop Trauma. 1995 Feb;9(1):1-7.

Rationale for inclusion: Prospective randomized trial evaluating sequential leg compression devices (versus no prophylaxis) in orthopedic trauma patients, showing reduction of VTE in patients with hip fractures.

Citations - 156 (as of July 2017)

A prospective study of venous thromboembolism after major trauma.
Geerts WH, Code KI, Jay RM, Chen E, Szalai JP.
N Engl J Med. 1994 Dec 15;331(24):1601-6.

Rationale for inclusion: Initial study that showed that VTE is common among trauma patients, occurring in 58% of patients.

Citations - 1260 (as of July 2017)

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