Michetti et al identified risk factors for deep vein thrombosis (DVT) in patients receiving acute inpatient rehabilitation following trauma. These can help to identify a patient who may benefit from more aggressive management. The authors are from Inova Fairfax Hospital in Falls Church, Virginia.

Patient selection: adult receiving acute inpatient rehabilitation after major trauma


Outcome: deep vein thrombosis


Patient factors associated with increased risk of DVT:

(1) age >= 50 years (risk greater if > 65 years)

(2) longer length of stay in the ICU (>= 4 days, risk greater if > 10 days)

(3) pelvic fracture(s)


Therapeutic factors associated with increased risk of DVT:

(1) delay in starting chemoprophylactic anticoagulation

(2) lapses in receipt of chemoprophylactic anticoagulation (therapy on <= 65% of days)


Highest risk patient:

(1) age > 65 years

(2) > 10 days in ICU

(3) gaps in prophylactic anticoagulation

(4) pelvic trauma


The authors noted that deep vein thrombosis on admission for rehabilitation was infrequent so screening initially was not warranted. If multiple risk factors are present then screening may be justified.

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