Document Detail

The effects of location and low-molecular-weight heparin administration on deep vein thrombosis outcomes in trauma patients.
MedLine Citation:
PMID:  23354241     Owner:  NLM     Status:  MEDLINE    
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 PE may result in less aggressive therapy. The purposes of this study were 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-extremity DVT were included in this study. Patients were classified by location of lower-extremity DVT 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 DVT were 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 DVT overall was not different (3.3% and 4.7%, p = 0.59). To assess DVT outcomes, 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.
LEVEL OF EVIDENCE: Therapeutic study, level IV; epidemiologic study, level III.
Tim H Lee; Brock J Alonzo; Jerome Differding; Samantha J Underwood; Greg Hamilton; Igor Kremenevskiy; Steve McNamara; Martin A Schreiber
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  74     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-04-05     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  476-81     Citation Subset:  AIM; IM    
Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.
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MeSH Terms
Enoxaparin / therapeutic use
Fibrinolytic Agents / therapeutic use*
Heparin, Low-Molecular-Weight / therapeutic use*
Injury Severity Score
Leg / blood supply
Length of Stay
Middle Aged
Pulmonary Embolism / etiology,  prevention & control
Retrospective Studies
Treatment Outcome
Ultrasonography, Doppler, Duplex
Venous Thrombosis / etiology,  pathology,  prevention & control*,  ultrasonography
Wounds and Injuries / complications*,  drug therapy
Reg. No./Substance:
0/Enoxaparin; 0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight

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