PREVENTION OF VENOUS THROMBOEMBOLISM IN TRAUMA PATIENTS

Trauma patients are at risk for thromboembolic complications, but effe ctive methods of prophylaxis have not been established for this hetero genous population. In this prospective trial, 400 trauma patients were assigned to one of three groups, depending upon their injuries, and r andomized within each group to a treatment mode: Group I: sequential g radient pneumatic leg compression (SCD), low-dose subcutaneous heparin (H), or control (C); Group II: H or C; Group HI: SCD or C. Venous dup lex ultrasound examinations were performed on admission and weekly the reafter. Of the 251 patients who completed the study, 15 (6%) develope d lower extremity venous thrombosis and two additional patients develo ped pulmonary embolism (one fatal). Significant risk factors associate d with the development of thromboembolism included immobilization > 3 days, age 30 years or older, and the presence of pelvic or lower extre mity fractures. In patients with neurotrauma who cannot receive hepari n (Group III), the SOD was more effective than control in preventing D VT (p = 0.057). Neither H nor SCD appeared to offer protection for the other groups of trauma patients, but surveillance with ultrasound exa minations allowed for prompt recognition and treatment of occult deep vein thrombosis.