The effects of location and low-molecular-weight heparin administration on deep vein thrombosis outcomes in trauma patients

Tim H. Lee, Brock J. Alonzo, Jerome Differding, Samantha J. Underwood, Greg Hamilton, Igor Kremenevskiy, Steve McNamara, Martin Schreiber

    Research output: Contribution to journalArticle

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    Abstract

    BACKGROUND: Deep vein thrombosis (DVT) is common after trauma. Pulmonary embolism (PE) is a feared complication of DVT. Standard doses of low-molecular-weight heparin (LMWH) are commonly used to prevent and treat DVT and PE. There is variable bioavailability of LMWH with standard therapy. The traditional concept that below-knee DVT is associated with a lower risk of subsequent PEmay result in less aggressive therapy. The purposes of this studywere to assess the rates of PE in above-knee versus below-knee DVT and longitudinally evaluate outcomes of DVT treated with LMWH therapy. METHODS: This was a retrospective review of patients at a university Level I trauma center during the years 2005 through 2010. Patients diagnosed with lower- extremityDVTwere included in this study. Patientswere classified by location of lower-extremityDVT and type of LMWH therapy received. All high-risk trauma patients were evaluated with weekly duplex Doppler ultrasonography. All duplex studies were reviewed for DVT resolution or improvement. Symptomatic patients were evaluated with computed tomographic angiography to rule out PE. Demographics, total length of hospital stay, length of intensive care unit stay, and Injury Severity Score (ISS) were collected. RESULTS: Three-hundred eight trauma patients with lower-extremity DVTwere included. More patients developed below-knee DVT (65.6%) compared with above-knee DVT (34.4%). Increased length of hospital stay, intensive care unit stay, and higher ISS were noted in patients with above-knee DVT. More patients had below-knee DVT in the prophylactic dosing group. With LMWH therapy, three PEs occurred in patients in the prophylactic dosing group with below-knee DVT, and no PEs occurred in the therapeutic treatment group. The incidence of PE between patients with below-knee DVT compared with above-knee DVToverallwas not different (3.3%and 4.7%, p = 0.59). To assess DVToutcomes, 157 of the 308 patients had serial duplex studies following diagnosis of lower-extremity DVT. The number of patients receiving either therapeutic or prophylactic LMWH was similar (51% and 49%). There was no difference in rates of resolution or improvement between LMWH dosing groups or location of DVT. CONCLUSION: In screened trauma patients, below-knee DVT is more common than above-knee DVT. There was no difference in the incidence of PE between groups. Standard prophylactic and therapeutic dosing of LMWH does not affect the rates of resolution or improvement of lower-extremity DVT. Rates of resolution and improvement of DVT is not dependent of location of lower-extremity DVT.

    Original languageEnglish (US)
    Pages (from-to)476-481
    Number of pages6
    JournalJournal of Trauma and Acute Care Surgery
    Volume74
    Issue number2
    DOIs
    StatePublished - Feb 2013

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    Low Molecular Weight Heparin
    Venous Thrombosis
    Wounds and Injuries
    Knee
    Pulmonary Embolism
    Lower Extremity
    Length of Stay
    Injury Severity Score
    Therapeutics
    Intensive Care Units
    Doppler Duplex Ultrasonography
    Trauma Centers

    Keywords

    • Low-molecular-weight heparin
    • Lower-extremity deep venous thrombosis
    • Pulmonary embolism

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    The effects of location and low-molecular-weight heparin administration on deep vein thrombosis outcomes in trauma patients. / Lee, Tim H.; Alonzo, Brock J.; Differding, Jerome; Underwood, Samantha J.; Hamilton, Greg; Kremenevskiy, Igor; McNamara, Steve; Schreiber, Martin.

    In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 2, 02.2013, p. 476-481.

    Research output: Contribution to journalArticle

    Lee, Tim H. ; Alonzo, Brock J. ; Differding, Jerome ; Underwood, Samantha J. ; Hamilton, Greg ; Kremenevskiy, Igor ; McNamara, Steve ; Schreiber, Martin. / The effects of location and low-molecular-weight heparin administration on deep vein thrombosis outcomes in trauma patients. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 2. pp. 476-481.
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    abstract = "BACKGROUND: Deep vein thrombosis (DVT) is common after trauma. Pulmonary embolism (PE) is a feared complication of DVT. Standard doses of low-molecular-weight heparin (LMWH) are commonly used to prevent and treat DVT and PE. There is variable bioavailability of LMWH with standard therapy. The traditional concept that below-knee DVT is associated with a lower risk of subsequent PEmay result in less aggressive therapy. The purposes of this studywere to assess the rates of PE in above-knee versus below-knee DVT and longitudinally evaluate outcomes of DVT treated with LMWH therapy. METHODS: This was a retrospective review of patients at a university Level I trauma center during the years 2005 through 2010. Patients diagnosed with lower- extremityDVTwere included in this study. Patientswere classified by location of lower-extremityDVT and type of LMWH therapy received. All high-risk trauma patients were evaluated with weekly duplex Doppler ultrasonography. All duplex studies were reviewed for DVT resolution or improvement. Symptomatic patients were evaluated with computed tomographic angiography to rule out PE. Demographics, total length of hospital stay, length of intensive care unit stay, and Injury Severity Score (ISS) were collected. RESULTS: Three-hundred eight trauma patients with lower-extremity DVTwere included. More patients developed below-knee DVT (65.6{\%}) compared with above-knee DVT (34.4{\%}). Increased length of hospital stay, intensive care unit stay, and higher ISS were noted in patients with above-knee DVT. More patients had below-knee DVT in the prophylactic dosing group. With LMWH therapy, three PEs occurred in patients in the prophylactic dosing group with below-knee DVT, and no PEs occurred in the therapeutic treatment group. The incidence of PE between patients with below-knee DVT compared with above-knee DVToverallwas not different (3.3{\%}and 4.7{\%}, p = 0.59). To assess DVToutcomes, 157 of the 308 patients had serial duplex studies following diagnosis of lower-extremity DVT. The number of patients receiving either therapeutic or prophylactic LMWH was similar (51{\%} and 49{\%}). There was no difference in rates of resolution or improvement between LMWH dosing groups or location of DVT. CONCLUSION: In screened trauma patients, below-knee DVT is more common than above-knee DVT. There was no difference in the incidence of PE between groups. Standard prophylactic and therapeutic dosing of LMWH does not affect the rates of resolution or improvement of lower-extremity DVT. Rates of resolution and improvement of DVT is not dependent of location of lower-extremity DVT.",
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    author = "Lee, {Tim H.} and Alonzo, {Brock J.} and Jerome Differding and Underwood, {Samantha J.} and Greg Hamilton and Igor Kremenevskiy and Steve McNamara and Martin Schreiber",
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    T1 - The effects of location and low-molecular-weight heparin administration on deep vein thrombosis outcomes in trauma patients

    AU - Lee, Tim H.

    AU - Alonzo, Brock J.

    AU - Differding, Jerome

    AU - Underwood, Samantha J.

    AU - Hamilton, Greg

    AU - Kremenevskiy, Igor

    AU - McNamara, Steve

    AU - Schreiber, Martin

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    Y1 - 2013/2

    N2 - BACKGROUND: Deep vein thrombosis (DVT) is common after trauma. Pulmonary embolism (PE) is a feared complication of DVT. Standard doses of low-molecular-weight heparin (LMWH) are commonly used to prevent and treat DVT and PE. There is variable bioavailability of LMWH with standard therapy. The traditional concept that below-knee DVT is associated with a lower risk of subsequent PEmay result in less aggressive therapy. The purposes of this studywere to assess the rates of PE in above-knee versus below-knee DVT and longitudinally evaluate outcomes of DVT treated with LMWH therapy. METHODS: This was a retrospective review of patients at a university Level I trauma center during the years 2005 through 2010. Patients diagnosed with lower- extremityDVTwere included in this study. Patientswere classified by location of lower-extremityDVT and type of LMWH therapy received. All high-risk trauma patients were evaluated with weekly duplex Doppler ultrasonography. All duplex studies were reviewed for DVT resolution or improvement. Symptomatic patients were evaluated with computed tomographic angiography to rule out PE. Demographics, total length of hospital stay, length of intensive care unit stay, and Injury Severity Score (ISS) were collected. RESULTS: Three-hundred eight trauma patients with lower-extremity DVTwere included. More patients developed below-knee DVT (65.6%) compared with above-knee DVT (34.4%). Increased length of hospital stay, intensive care unit stay, and higher ISS were noted in patients with above-knee DVT. More patients had below-knee DVT in the prophylactic dosing group. With LMWH therapy, three PEs occurred in patients in the prophylactic dosing group with below-knee DVT, and no PEs occurred in the therapeutic treatment group. The incidence of PE between patients with below-knee DVT compared with above-knee DVToverallwas not different (3.3%and 4.7%, p = 0.59). To assess DVToutcomes, 157 of the 308 patients had serial duplex studies following diagnosis of lower-extremity DVT. The number of patients receiving either therapeutic or prophylactic LMWH was similar (51% and 49%). There was no difference in rates of resolution or improvement between LMWH dosing groups or location of DVT. CONCLUSION: In screened trauma patients, below-knee DVT is more common than above-knee DVT. There was no difference in the incidence of PE between groups. Standard prophylactic and therapeutic dosing of LMWH does not affect the rates of resolution or improvement of lower-extremity DVT. Rates of resolution and improvement of DVT is not dependent of location of lower-extremity DVT.

    AB - BACKGROUND: Deep vein thrombosis (DVT) is common after trauma. Pulmonary embolism (PE) is a feared complication of DVT. Standard doses of low-molecular-weight heparin (LMWH) are commonly used to prevent and treat DVT and PE. There is variable bioavailability of LMWH with standard therapy. The traditional concept that below-knee DVT is associated with a lower risk of subsequent PEmay result in less aggressive therapy. The purposes of this studywere to assess the rates of PE in above-knee versus below-knee DVT and longitudinally evaluate outcomes of DVT treated with LMWH therapy. METHODS: This was a retrospective review of patients at a university Level I trauma center during the years 2005 through 2010. Patients diagnosed with lower- extremityDVTwere included in this study. Patientswere classified by location of lower-extremityDVT and type of LMWH therapy received. All high-risk trauma patients were evaluated with weekly duplex Doppler ultrasonography. All duplex studies were reviewed for DVT resolution or improvement. Symptomatic patients were evaluated with computed tomographic angiography to rule out PE. Demographics, total length of hospital stay, length of intensive care unit stay, and Injury Severity Score (ISS) were collected. RESULTS: Three-hundred eight trauma patients with lower-extremity DVTwere included. More patients developed below-knee DVT (65.6%) compared with above-knee DVT (34.4%). Increased length of hospital stay, intensive care unit stay, and higher ISS were noted in patients with above-knee DVT. More patients had below-knee DVT in the prophylactic dosing group. With LMWH therapy, three PEs occurred in patients in the prophylactic dosing group with below-knee DVT, and no PEs occurred in the therapeutic treatment group. The incidence of PE between patients with below-knee DVT compared with above-knee DVToverallwas not different (3.3%and 4.7%, p = 0.59). To assess DVToutcomes, 157 of the 308 patients had serial duplex studies following diagnosis of lower-extremity DVT. The number of patients receiving either therapeutic or prophylactic LMWH was similar (51% and 49%). There was no difference in rates of resolution or improvement between LMWH dosing groups or location of DVT. CONCLUSION: In screened trauma patients, below-knee DVT is more common than above-knee DVT. There was no difference in the incidence of PE between groups. Standard prophylactic and therapeutic dosing of LMWH does not affect the rates of resolution or improvement of lower-extremity DVT. Rates of resolution and improvement of DVT is not dependent of location of lower-extremity DVT.

    KW - Low-molecular-weight heparin

    KW - Lower-extremity deep venous thrombosis

    KW - Pulmonary embolism

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