POSTTRAUMA THROMBOEMBOLISM PROPHYLAXIS

Purpose: The need to study methods of thromboembolism prophylaxis in h igh-risk trauma patients is well established. The purpose of this stud y was to evaluate the feasibility of a proposed study design, includin g current methods of prophylaxis, performance of a risk assessment pro file scale, and the use of serial color-flow duplex studies in detecti ng deep venous thrombosis (DVT). Methods: Patients were enrolled into the study, stratified as to their ability to receive anticoagulation a nd randomized to low-dose unfractionated heparin, low molecular weight heparin, pneumatic compression devices, or foot pumps with or without vena caval filters, Serial ultrasound scans were performed at designa ted intervals for 4 weeks, Pulmonary angiograms were obtained for clin ical signs or symptoms of pulmonary embolism. Results: Fifty-three pat ients, 32 male and 21 female patients with a mean age of 44 years, com pleted the study, The incidence of DVT was 43% (23 of 53 patients) and significantly higher in older patients, There were no pulmonary embol isms, Color-flow duplex proved to be a sensitive method for detecting both proximal and distal thrombi, The risk assessment profile for thro mboembolism (RAPT) scale identified a group of patients with a high in cidence of DVT. However, the occurrence of DVT was not correlated with the magnitude of the RAPT score. Conclusion: The ability to identify a population with a high incidence of thromboembolism by using the RAP T score to detect asymptomatic DVT, and the suggested advantage of low molecular weight heparin, all support the need for an appropriately p owered randomized clinical trial.