EFFICACY OF DEEP VENOUS THROMBOSIS PROPHYLAXIS IN TRAUMA PATIENTS ANDIDENTIFICATION OF HIGH-RISK GROUPS

The incidence of deep venous thrombosis (DVT) and the efficacy of prop hylactic measures were prospectively evaluated in all patients admitte d to a level 1 trauma center during 1991. Patients with injury Severit y Scores (ISS) >9 who survived a minimum of 48 hours (n = 395) were mo nitored using venous Doppler and ultrasound studies during hospitaliza tion (total, 1308 studies). Two hundred eighty-one patients (71%) were randomly assigned to low-dose heparin or sequential compression devic es. There were 18 cases of lower extremity DVT (4.6%) and four cases ( 1.0%) of pulmonary emboli (PE), three of which were fatal. Eight patie nts (2.9%) on prophylaxis and 10 (8.8%) without prophylaxis developed DVT (p < 0.02 by Chi-square). There were two PEs in each group. Fourte en of these 18 patients sustained blunt trauma and included seven spin al fractures or subluxations (four paraplegic) and four severe head in juries. This represented 14.0% of 50 patients admitted with spinal inj uries and 4.3% of 92 patients with severe head injuries. Compared with those with no neurologic injury (7 of 253 or 2.7%), the risk of DVT i s significantly higher in the spinal injury patients (p < 0.001, Chi-s quare) and twice as high as in the head injury group, although not sta tistically significant (p = 0.4, Chi-square). Three of the four patien ts with penetrating trauma and DVT had venous injuries. We conclude th at DVT prophylaxis can significantly reduce the incidence of DVT in tr auma patients with ISS >9. Patients with severe neurologic injuries (p articularly spinal cord) are at high risk for DVT and PE and may be co nsidered for a prophylactic Greenfield filter.