Table 1:
Summary of Strategies to Prevent Venous Thromboembolism in Trauma
| VTE Prevention Strategy | Previously Accepted Practice Patterns | Evolving VTE Prophylaxis Evidence | Future Directions and Unanswered Questions |
|---|---|---|---|
| Alternative Low Molecular Weight Heparin (LMWH) Dosing Strategies | Fixed dosing of LMWH at 30-mg twice daily in trauma patients. | • Anti-Xa guided LMWH dosing. • Weight-based LMWH dosing. • Thromboelastography (TEG) guided LMWH dosing. • Creatinine clearance based dosing |
• Development of standardized strategy for prophylactic LMWH dosing • Implications of antithrombin III activity in VTE formation • Assessment of safety of weight based LMWH dosing in trauma subpopulations at elevated bleeding risk • Role of TEG with platelet mapping in characterizing trauma hypercoagulability |
| Mechanical Prophylaxis and Mobilization | Sequential compression device (SCD) use and early mobilization of trauma patients as part of VTE prevention regimen. | • Chemoprevention is superior to SCDs and mobilization for VTE prevention. • Mobilization alone may not reduce VTE rates. |
May have limited utility in patients already receiving chemoprophylaxis. |
| Prophylactic Inferior Vena Cava Filters (IVCF) | Prophylactic IVCF placement in trauma patients at particularly high risk for bleeding. | • May not prevent symptomatic PE. • Mortality benefit has not been shown. |
Fallen out of favor due to limited added benefit in those on chemoprophylaxis. low rate of retrieval, and risk for vascular complications. Consideration is reserved for those at highest risk for bleeding. |
| Extended/Outpatient Thromboprophylaxis | No standard accepted guidelines for chemoprophylaxis in trauma patients following discharge, however a benefit is suggested based on orthopedic literature. | • LMWH, direct oral anticoagulants (DOACs), and aspirin promising for extended VTE prevention. • Minimum 4-weeks extended chemoprophylaxis in high-risk patients. |
• Optimal agent for outpatient extended VTE prophylaxis • Determination of duration of extended chemoprophylaxis • Outpatient regimen may be determined by VTE risk stratification |