Document Detail

Thromboprophylaxis and VTE rates in soldiers wounded in Operation Enduring Freedom and Operation Iraqi Freedom.
MedLine Citation:
PMID:  23539197     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: US soldiers suffer catastrophic injuries during combat. We sought to define risk factors and rates for VTE in this population.
METHODS: We gathered data each hospital day on all patients injured in Afghanistan or Iraq who were admitted to the Walter Reed Army Medical Center (WRAMC). We analyzed prophylaxis rates and efficacy and identified risk factors for VTE.
RESULTS: We recorded data on 506 combat casualties directly admitted to WRAMC after medical air evacuation. The average injury severity score for the group was 18.4 ± 11.7, and the most common reason for air evacuation was injury by improvised explosive device (65%). As part of the initial resuscitation, patients received 4.7 ± 9.0 and 4.00 ± 7.8 units of packed RBCs and fresh frozen plasma, respectively, and 42 patients received factor VIIa. Forty-six patients (9.1%) were given a diagnosis of VTE prior to discharge, 18 (3.6%) during air evacuation, and 28 (5.5%) during the hospital stay. In Cox regression analysis, administration of 1 unit of packed RBCs was associated with a hazard ratio (HR) of 1.04 (95% CI, 1.02-1.07; P = .002), and enoxaparin, 30 mg bid, administered subcutaneously for the majority of hospital days was associated with a HR of 0.31 (95% CI, 0.11-0.86; P = .02) for VTE during the hospitalization.
CONCLUSIONS: Patients who suffer traumatic injuries in combat overseas are at high risk for VTE during evacuation and recovery. Those with large resuscitations are at particularly high risk, and low-molecular-weight heparin is associated with a decrease in VTE.
Aaron B Holley; Sarah Petteys; Joshua D Mitchell; Paul R Holley; Jacob F Collen
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Chest     Volume:  144     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-09-06     Completed Date:  2014-01-07     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  966-73     Citation Subset:  AIM; IM    
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MeSH Terms
Afghan Campaign 2001-
Follow-Up Studies
Heparin, Low-Molecular-Weight / administration & dosage*
Hospitals, Military*
Injections, Subcutaneous
Iraq War, 2003-2011
Military Personnel*
Retrospective Studies
Risk Factors
Survival Rate / trends
Treatment Outcome
United States / epidemiology
Venous Thromboembolism / epidemiology,  prevention & control*
Reg. No./Substance:
0/Heparin, Low-Molecular-Weight
Comment In:
Chest. 2014 Jan;145(1):195   [PMID:  24394847 ]
Chest. 2014 Jan;145(1):195-6   [PMID:  24394848 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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