Adams et al reported a protocol for prevention of thromboembolic disease in a trauma patient. These can help identify a patient who may benefit from prophylactic therapy. The authors are from Memorial Health University Medical Center (MHUMC) in Savannah, Georgia.
Patient selection: major trauma, at > 48 hours since admission
Parameters:
(1) ambulatory status
(2) risk of thromboembolic disease (see previous section)
(3) contraindications to sequential compression devices (SCD)
(4) contraindications to low molecular weight heparin (LMWH)
(5) findings on Duplex studies for deep vein thrombosis
Duplex studies were performed every week in patients high risk for venous thromboembolism (DVT) or nonambulatory patients.
If the Duplex studies are positive for deep vein thrombosis, then therapy is started.
|
Ambulatory |
Risk DVT |
Can Wear SCD? |
Can Take LMWH? |
Therapy |
|
yes |
low |
NA |
NA |
none |
|
yes |
high |
yes |
yes |
SCD in bed, LMWH |
|
yes |
high |
no |
yes |
LMWH |
|
yes |
high |
yes |
no |
SCD in bed |
|
yes |
high |
no |
no |
alternative to LMWH or IVC filter |
|
no |
NA |
yes |
yes |
SCD and LMWH |
|
no |
NA |
no |
yes |
LMWH |
|
no |
NA |
yes |
no |
SCD |
|
no |
NA |
no |
no |
alternative to LMWH or IVC filter |
where:
• IVC filter = inferior vena cava filter
• Contraindications to SCD included significant foot or ankle injuries.
• Contraindications to LMWH included solid organ injury, severe closed head injury, spinal cord injury and serious heparin-induced thrombocytopenia.
Specialty: Hematology Oncology, Clinical Laboratory
ICD-10: ,
