INABILITY OF AN AGGRESSIVE POLICY OF THROMBOPROPHYLAXIS TO PREVENT DEEP VENOUS THROMBOSIS (DVT) IN CRITICALLY INJURED PATIENTS - ARE CURRENT METHODS OF DVT PROPHYLAXIS INSUFFICIENT

Background: Deep venous thrombosis (DVT) in severely Injured patients is a life-threatening complication. Effective and safe thromboprophyla xis is highly desirable to prevent DVT. Low-dose heparin (LDH) and seq uential compression device (SCDs) are the most frequently used methods . Inappropriate use of these methods because of the nature or site of critical injuries leg, brain lesion, solid visceral or retroperitoneal hematoma, extremity fractures) may lead to failure of DVT prophylaxis . Study Design: A prospective study was performed to evaluate the effi cacy of a policy of aggressive use of LDH and SCDs in patients who are at very high risk for DVT. From January 1996 to August 1997, 200 crit ically injured patients were followed by weekly Doppler examinations t o detect DVT at the proximal lower extremities. Only 3 patients did no t receive any thromboprophylaxis. SCDs were applied in 97.5% and LDH w as administered to 46% of the patients; 45% had both. Results: DVT was found in 26 patients (13%). The majority (58%) developed DVT within t he first 2 weeks, but new cases were found as late as 12 weeks after a dmission. The incidence of DVT was the same among patients who had SCD s only or a combination of LDH and SCDs. Mechanism of Injury, type and number of operations, site: of injury, Injury Severity Score, and the ; incidence of femoral lines were not different between patients with and without DVT. Differences were found in the severity of injury to t he chest and the extremities and the need for high-level respiratory s upport. Patients with DVT had prolonged ICU and hospital stays (on ave rage, 34 and 49 days, respectively) and a high mortality rate (31%). C onclusions: The incidence of DVT remains high among severely injured p atients despite aggressive thromboprophylaxis. A combination of LDH an d an SCD showed no advantage over SCD alone in decreasing DVT rates. R isk factors in this group of patients who are already at very high ris k are hard to detect; Doppler examinations are justified for surveilla nce in all critically injured patients. Current methods of thromboprop hylaxis seem to offer limited efficacy, and the search for more effect ive methods should continue. (J Am Cell Surg 1998;187:529-533, (C) 199 8 by the American College of Surgeons).