Venous Thromboembolism: Role of Low-Molecular-Weight Heparin in VTE Prophylaxis

Published 2002

Level 1

A Level I recommendation on this topic cannot be supported because of insufficient data.

Level 2

LMWH can be used for VTE prophylaxis in trauma patients with the following injury patterns:

  1. Pelvic fractures requiring operative fixation or prolonged bed rest (> 5 days).
  2. Complex lower extremity fractures (defined as open fractures or multiple fractures in one extremity) requiring operative fixation or prolonged bed rest (> 5 days).
  3. Spinal cord injury with complete or incomplete motor paralysis. The use of LMWH is predicated on the fact that these patients do not have other injuries that put them at high risk for bleeding.

Level 3

  1. Trauma patients with an ISS > 9, who can receive anticoagulants, should receive LMWH as their primary mode of VTE prophylaxis.
  2. LMWH has not been sufficiently studied in the head-injured patient with intracranial bleeding to justify its use at this time.
  3. LMWH should not be used when epidural catheters are placed or removed.