Contemporary thromboprophylaxis of trauma patients

    Research output: Contribution to journalReview article

    2 Scopus citations

    Abstract

    Purpose of review The traumatically injured patient is at high risk for developing venous thromboembolism. Clinical practice guidelines developed by the American College of Chest Physicians and the Eastern Association for the Surgery of Trauma recognize the importance of initiating thromboprophylaxis, but the guidelines lack specific recommendations regarding the timing and dose of pharmacologic thromboprophylaxis. We review the literature regarding initiation of thromboprophylaxis in different injuries, the use of inferior vena cava filters, laboratory monitoring, dosing regimens, and the use of antiplatelet therapy. Recent findings Use of pharmacologic thromboprophylaxis with invasive intracranial monitors is not associated with increased bleeding complications. The initiation of low-molecular-weight heparin (LMWH) prophylaxis 48 h postinjury in blunt solid organ injury is not associated with an increase in the rate of failed nonoperative management. Antiplatelet therapy in conjunction with LMWH may help to prevent venous thromboembolism. Summary In the setting of blunt traumatic brain and solid organ injury, initiation of pharmacologic thromboprophylaxis 48 h after injury is not associated with increased bleeding complications. There is no consensus or clear data showing which dosing regimen of LMWH is most effective or whether routine laboratory measurements are beneficial for determining effective thromboprophylaxis.

    Original languageEnglish (US)
    Pages (from-to)607-612
    Number of pages6
    JournalCurrent Opinion in Critical Care
    Volume22
    Issue number6
    DOIs
    StatePublished - Nov 13 2016

    Keywords

    • Antifactor Xa
    • Enoxaparin
    • Low-molecular-weight heparin
    • Thrombelastography
    • Thromboprophylaxis
    • Trauma

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

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