Inflammation and the Host Response to Injury a Large-Scale Collaborative Project: Patient-Oriented Research Core Standard Operating Procedure for Clinical Care X. Guidelines for Venous Thromboembolism Prophylaxis in the Trauma Patient

Venous thromboembolism (VTE) in seriously injured patients is a common problem that can potentially lead to Substantial morbidity, mortality, and resource expenditure.(1-3) In fact, patients recovering from trauma have the highest rate of VTE among all subgroups of hospitalized patients.(4) Depending on the patient cohort and diagnostic modality. rates of deep venous thrombosis (DVT) and pulmonary embolism (PE) may be as high as 40% and 20%, respectively.(5.6) Not only is the development of VTE in the form of a massive PE a cause of late death in the injured patient, VTE development anytime after injury complicates management and can lead to significant long-term sequelae. To reduce the risk of VTE, many practitioners administer mechanical or pharmacologic thromboprophylaxis or both. Although, numerous interventions have been evaluated L I for potential efficacy in preventing VTE in selected subpopulations Of injured patients, the data on the optimal method of prophylaxis that balances risk of VTE with risk of complications from therapy remains inconclusive.(7.8) On the basis of the current data. several evidence-based guidelines have been proposed with varying degrees of application and effectiveness, primarily due to concerns of increased bleeding.(6) However, delay in the initiation of prophylaxis is associated with a 3-fold increase in the incidence of VTE.(9) This increased incidence in VTE occurring with delayed initiation is most likely secondary to an earlier than expected development of VTE. In fact. VTE has been diagnosed in a significant number of patients within the first 24 hours after injury and approximately one-third of all cases of VTE are diagnosed within 1 week of injury.(9.10) The lack of consistent data emphasizes the need for adequately designed prospective evaluations to define optimal practice in this area. As part of the Inflammation and the Host Response to Injury Large-Scale Collaborative Research Program, the participating investigators have developed guidelines for VTE prophylaxis based on best available evidence and expert opinion to standardize this aspect of care among participating centers.