Low Risk Trauma Patients w/ Lower Extremity Fracture:
- coumadin, low molecular weight dextran, adjusted dose heparin, or low molecular weight heparin are proven effective for patients undergoing elective surgery
- prophylaxis may be considered for patients with risk factors (female, obese, birth control, smoking ect).
- Prophylaxis of deep-vein thrombosis in fractures below the knee: a prospective randomised controlled trial.
- Efficacy and safety of rivaroxaban versus low-molecular-weight heparin therapy in patients with lower limb fractures.
- Symptomatic venous thromboembolism following fractures distal to the knee: a nationwide danish cohort study.
- UK national survey of venous thromboembolism prophylaxis in ankle fracture patients treated with plaster casts.
- Incidence of deep-vein thrombosis in patients with fractures of the ankle treated in a plaster cast.
- Deep vein thrombosis following below knee immobilization: the need for chemoprophylaxis.
- Risk factors of venous thrombosis in patients with ankle fractures
High Risk Trauma Patients:
Vena cava filter
- in multi-trauma patients consider prophylactic placement of a vena cava filter
- decrease in incidence of pulmonary embolism can be expected
- filters should remove 98% of emboli
- filters can be expected to prevent fatal emboli in about 2-4% of patients undergoing major acetabular fixation (as compared to patients
who receive other forms of DVT prophylaxis)
- long-term patency rate of IVC is about 94% at 1-2 years
- sudden severe leg edema following filter insertion may indicate the occurance of a large embolus
- criteria for filter placement (2/5 criteria must be met)
- age greater than 55 yrs
- ISS greater than 16
- complex pelvic fracture
- long bone and pelvic fracture
- fracture (pelvic / lower extremity) requiring prolonged bed rest
- in the study by Wojcik, et al. (2000), long-term complications of VCF placement were 191 VCFs, mean follow-up of 28.9 months
- 41 VCFs were placed in patients with DVT or pulmonary embolism, and 64 were placed in patients for prophylactic
- there were no pulmonary embolisms detected after VCF insertion
- only one filter (0.95%) migrated, and this was minimal (1 cm cephalad)
- 1 (0.95%) vena cava was occluded, based on duplex ultrasonography, and 11 patients (10.4%) had signs or symptoms
of leg swelling after hospital discharge
- 28 (44%) of the 64 patients with prophylactic VCFs developed a DVT after filter placement
- VCFs placed in trauma patients have acceptable short- and long-term complication rates
- consideration should be given to prophylactic VCF placement in patients at high risk for VTE
- randomized controlled trials are needed to evaluate whether VCF insertion increases the risk for subsequent DVT
- Long-Term Follow-Up of Trauma Patients with a Vena Caval Filter
- Magnetic resonance venography to evaluate the deep venous system of the pelvis in patients who have an acetabular fracture.
- Prophylactic vena cava filter insertion in selected high risk orthopaedic trauma patients.
- Greenfield filter prophylaxis of pulmonary embolism in patients undergoing surgery for acetabular fracture.
- Thromboembolism following multiple trauma.
- Risk of pulmonary emboli in patients with pelvic fractures.
- Prophylaxis against deep-vein thrombosis following trauma: a prospective, randomized comparison of mechanical and pharmacologic prophylaxis.
- Long-term consequences of pelvic trauma patients with thromboembolic disease treated with inferior vena caval filters.
Original Text by Clifford R. Wheeless, III, MD.