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Prevention of Venous Thromboembolism in Trauma Patients

Dual prophylaxis with mechanical foot pumps and delayed enoxaparin was at least as effective as early prophylaxis with enoxaparin alone.

Venous thromboembolism is an important complication among patients who are hospitalized after traumatic injury. Preventive interventions that don't rely solely on anticoagulation are desirable to minimize risk for bleeding.

In this randomized trial that involved 200 patients with severe blunt trauma and fractures of the femur, tibia, pelvis, or acetabulum, researchers compared two preventive strategies. Group A received enoxaparin (30 mg twice daily), starting 24 to 48 hours after injury. Group B received mechanical foot pumps starting at admission and then received delayed enoxaparin starting on day 5. All patients were screened for deep-vein thrombosis (DVT) just before hospital discharge, or earlier if symptoms occurred.

DVT was diagnosed in 13.4% of group A patients and in 8.7% of group B patients — a nonsignificant difference. However, the incidence of large (>2 cm) or completely occlusive clots was significantly higher in group A than in group B (11.3% vs. 2.9%). Pulmonary embolism was diagnosed in two group A patients and no group B patients. Bleeding complications were similar in the groups.

Comment: Among patients with blunt trauma, dual prophylaxis with mechanical foot pumps and delayed enoxaparin was as effective as — and perhaps more effective than — early prophylaxis with enoxaparin alone. Although bleeding complications were not increased in the early enoxaparin group, initial use of foot pumps instead of anticoagulation would enable clinicians to delay difficult decisions about when to introduce prophylactic anticoagulation.

— Allan S. Brett, MD

Published in Journal Watch General Medicine March 10, 2006

Citation(s):

Stannard JP et al. Prophylaxis against deep-vein thrombosis following trauma: A prospective, randomized comparison of mechanical and pharmacologic prophylaxis. J Bone Joint Surg Am 2006 Feb; 88:261-6.

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