Timing of venous thromboembolism prophylaxis initiation after injury: Findings from the consensus conference to implement optimal VTE prophylaxis in trauma

Morgan Schellenberg, Todd Costantini, Bellal Joseph, Michelle A. Price, Andrew C. Bernard, Elliott R. Haut

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Optimizing prophylaxis against venous thromboembolic events (VTEs) is a critical issue in the care of injured patients. Although these patients are at significant risk of developing VTE, they also present competing concerns related to exacerbation of bleeding from existing injuries. Especially after high-risk trauma, including injuries to the abdominal solid organs, brain, and spine, trauma providers must delineate the time period in which VTE prophylaxis successfully reduces VTE rates without encouraging bleeding. Although existing data are primarily retrospective in nature and further study is required, literature supports early VTE chemoprophylaxis initiation even for severely injured patients. Early initiation is most frequently defined as <48 hours from admission but varies from <24 hours to 72 hours and occasionally refers to time from initial trauma. Prior to chemical VTE prophylaxis initiation in patients at risk for bleeding, an observation period is necessary during which injuries must show themselves to be hemostatic, either clinically or radiographically. In the future, prospective examination of optimal timing of VTE prophylaxis is necessary. Further study of specific subsets of trauma patients will allow for development of effective VTE mitigation strategies based upon collective risks of VTE and hemorrhage progression.

Original languageEnglish
Pages (from-to)484-489
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume94
Issue number3
DOIs
StatePublished - Mar 1 2023

Bibliographical note

Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • Venous thromboembolism
  • chemoprophylaxis
  • optimal timing
  • trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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