Early prophylaxis for venous thromboembolism (VTE) may not significantly increase risk for bleeding in severely injured patients, according to research published in the European Journal of Trauma and Emergency Surgery.
Researchers compared 2 level I trauma populations receiving different treatment protocols in 2 different countries. Cohort 1 consisted of 279 patients mean age of 52.9 years who were treated at the University Medical Center Utrecht (UMCU) in the Netherlands with early initiation of chemical prophylaxis. Cohort 2 consisted of 974 patients with a mean age of 51.9 years who were treated at Harborview Medical Center (HMC) in Seattle, Washington, with restrictive early chemical prophylaxis. All patients had been severely injured (with an Injurity Severity Score ≥ 16 or greater), were 18 years or older, and were treated in 2013.
A total of 75% of patients at UMCU and 81% of patients at HMC received thromboprophylaxis (P <.001), and 72% of patients at UMCU and 47% of patients at HMC were treated within 48 hours of arrival (P <.001). The primary outcomes were VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), and hemorrhagic complications.
Only 4 patients (1.4%) developed a VTE at UMCU (3 cases of PE; 1 case of DVT) compared with 37 patients (3.8%) at HMC (22 cases of PE; 16 cases of DVT; P =.06).
Of patients who developed VTE, VTE occurred during prophylaxis in 75% at UMCU and 81% at HMC. No significant differences were found between the 2 protocols for development of VTE (odds ratio [OR], 2.397; P =.102) or hemorrhagic complications (OR, 0. 586; P =.383) after adjusting for age, Injury Severity Score, hospital length of stay, and type of injury.
A greater percentage of patients at UMCU had traumatic brain injuries (TBI), but the researchers noted that early initiation of therapy appeared to be safe in these patients nonetheless.
“No significant difference was demonstrated in either the number of VTEs or hemorrhagic complications between the 2 treatment protocols,” the researchers concluded. “However, a noticeable trend with greater than 2-fold OR [for a bleeding complication] was present with more delayed initiation of treatment.”
1. Gunning AC, Maier RV, de Rooij D, et al. Venous thromboembolism (VTE) prophylaxis in severely injured patients: an international comparative assessment [published online August 30, 2019]. Eur J Trauma Emerg S. doi:10.1007/s00068-019-01208-z