Retrospective Evaluation of Venous Thromboembolism Prophylaxis in Elderly, High-Risk Trauma Patients.

Venous thromboembolism (VTE) risk increases with age. Scarce data exist for patients age ≥65 y. This study evaluated VTE incidence in elderly, high-risk trauma patients receiving unfractionated heparin (UFH) or enoxaparin chemoprophylaxis. This retrospective, single-center, cohort study included trauma patients age ≥ 65 y with risk assessment profile (RAP) ≥ 5 who received UFH or enoxaparin chemoprophylaxis. The primary outcome was VTE incidence requiring therapeutic anticoagulation. An age-modified RAP (RAP-AM) was calculated as RAP without age distribution points. Logistic regression analyses were performed to identify independent predictors for VTE development and chemoprophylactic agent selection. Bleeding incidence compared packed red blood cells utilized. A total of 1090 patients were included (UFH, n = 655; enoxaparin, n = 435). VTE occurred in 39 (3.6%) patients with no difference between groups in proximal deep vein thrombosis (2.1% versus 3.0%, P = 0.52) or pulmonary embolism (1.2% versus 1.4%, P = 0.96). Weight ≥125 kg (OR 4.12, 95% CI 1.06-16.11) and RAP-AM ≥ 5 (OR 6.52, 95% CI 2.65-16.03) were independently associated with VTE development. Increasing age (OR 1.04, 95% CI 1.03-1.06), initiation ≤ 24 h (OR 2.17, 95% CI 1.66-2.84) and creatinine clearance ≤ 30 mL/min (OR 1.61, 95% CI 1.17-2.21) were independent predictors of receiving UFH whereas increasing ISS (OR 0.97, 95% CI 0.95-0.99) was associated with receiving enoxaparin. VTE incidence may be similar for high-risk, elderly trauma patients receiving UFH and enoxaparin chemoprophylaxis. Further research is necessary to determine noninferiority of UFH to enoxaparin in this patient population.

Krantz EN ，Philpott CD ，Droege ME ，Mueller EW ，Ernst NE ，Garber PM ，Tsuei BJ ，Goodman MD ，Droege CA ... -  《-》

Heparin versus enoxaparin for prevention of venous thromboembolism after trauma: A randomized noninferiority trial.

Olson EJ ，Bandle J ，Calvo RY ，Shackford SR ，Dunne CE ，Van Gent JM ，Zander AL ，Sikand H ，Bongiovanni MS ，Sise MJ ，Sise CB ... -  《-》

A retrospective analysis of the effectiveness of low molecular weight heparin for venous thromboembolism prophylaxis in trauma patients.

In trauma patients, Enoxaparin (a low molecular weight heparin, LMWH) prophylaxis for venous thromboembolism (VTE) risk reduction is unproven. Cohort analysis conducted consisting of all trauma patients age >13 admitted to Level-I trauma center and hospitalized >48 hours. VTE risk determined by the Risk Assessment Profile. High risk patients received LMWH unless contraindicated, while low and moderate risk patients received LMWH at attending surgeon's discretion. Odds ratio for VTE by logistic regression. VTE incidence, relative risk (RR), and number needed to treat (NNT) to prevent deep vein thrombosis (DVT) or pulmonary embolism determined by risk category. Cohort consisted of 2,281 patients (1,211 low, 979 moderate, 91 high risks). VTE occured in 254 patients (11.1%). High-risk patients had significantly higher VTE incidence, odds ratio = 31.8 (P < .001). VTE was significantly reduced in high-risk patients receiving LMWH versus those who did not (.26 vs .53, P = .02). Among moderate and high risk, prophylactic LMWH reduced the incidence of pulmonary embolism (RR = .19, NNT = 40.4, P = .01), and trended toward reduced DVT incidence (RR = .81, NNT = 27.3, P = .15). LMWH lowered DVT incidence (RR = .52, NNT = 4.1, P = .03) in high risk patients. Prophylactic LMWH is associated with reduction of VTE in trauma patients.

Gritsiouk Y ，Hegsted DA ，Schlesinger P ，Gardiner SK ，Gubler KD ... -  《-》

Anti-Xa-guided enoxaparin thromboprophylaxis reduces rate of deep venous thromboembolism in high-risk trauma patients.

Singer GA ，Riggi G ，Karcutskie CA ，Vaghaiwalla TM ，Lieberman HM ，Ginzburg E ，Namias N ，Lineen EB ... -  《-》

Incidence of Symptomatic Venous Thromboembolisms in Stroke Patients.

Al Turk M ，Abraham M 《-》