DEEP VENOUS THROMBOSIS IN PATIENTS WITH M ULTIPLE INJURIES

The incidence of thromboembolic complications in patients with multipl e injuries was reviewed as well with respect to our own prospective in vestigation (141 patients with a mean injury severity score of 37 poin ts). The rate of deep venous thrombosis (DVT) in severely injured pati ents is reported to vary from 20 to 90% if invasive diagnostic procedu res are used, whereas the rate of clinically relevant manifestations o f DVT seems to be much lower. Although 96% of the patient population i n our study were thought to be at high risk of having DVT (applying ge nerally accepted risk factors), only 1.4% of the subjects actually dev eloped clinically relevant DVT. The analysis of several parameters of the coagulation and fibrinolytic systems (platelet count, prothrombin time, partial thromboplastin time, antithrombin III, prothrombin, plas minogen, tissue-plasminogen-activator and its inhibitor) showed simult aneous activation of both systems in these severely injured patients. Thus, increased coagulation seems to be counteracted by increased fibr inolysis. In addition, fluid resuscitation with crystalloid and colloi d infusions in the prehospital period (1970 ml and 573 ml, respectivel y) can be viewed as early prophylaxis of thromboembolic complications. Thus, the low DVT rate in a high-risk patient group with multiple inj uries might be at least partially explained.