Venous thromboembolism in patients with major trauma

Article Abstract:

It is believed that there is a high risk for the development of venous thromboembolism (VTE) following trauma. VTE is a blood clot that breaks off and travels through the circulation to another part of the body, where it blocks a blood vessel. The actual incidence of VTE in healthy, young trauma victims is not known. A study of 719 patients with major trauma is described. All patients were evaluated and categorized by number of risk factors for VTE; 542 had no risk factors, and 177 had at least one risk factor for VTE. Risk factors included: bed rest for more than three days and age over 45; history of thromboembolism; coma; fracture of the spine, pelvis or leg; quadriplegia or paraplegia; repair of a leg vein; and complex wound of the leg. No patients in the group with no risk factors developed VTE. Of the 177 patients with at least one risk factor, 12 (7 percent) did develop VTE. The most common method of prophylaxis, or prevention, was the use of pneumatic compression hose, or stockings. It was found that, because of the nature of the injuries or method of treatment (such as traction, cast or external mobilization), these stockings could not be used in 35 percent of the patients. The anti-clotting medication heparin, either alone or in combination with the stockings, was also used as prophylaxis. No method of prophylaxis could be used in 25 patients (14 percent) of the group with VTE risk factors; this was due to either the physical limitations of the treatment method or injury, or the presence of contraindications to the use of heparin. The only factor which was found able to predict VTE was an age older than 45 years. Also, the presence of more than one risk factor significantly increased the incidence of VTE over the presence of only one risk factor. It is concluded that a specific group of trauma patients is at risk for the development of VTE and should be treated with prophylaxis; however, one in seven are unable to be so treated because of the nature of their injuries. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Methods, Complications and side effects, Wounds and injuries, Trauma centers, Traumatology

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An overview of venous thromboembolism prophylaxis

Article Abstract:

Venous thromboembolism, a condition in which a clot breaks free and travels through the circulation, later lodging in a vessel and obstructing blood flow, is a major cause of illness and death. If no preventive measures are taken, venous thrombosis of the deep veins occurs in 25 to 33 percent of all patients undergoing general surgery. Although all patients are at risk for venous clots, the risk is increased for patients who have undergone trauma or major surgery or are seriously ill. Several risk factors have been identified: advanced age, obesity, cancer, immobility, previous thromboembolism, varicose veins, poor heart output or function, major injury, major surgery, and use of oral contraceptives. Various methods of prevention are available. Low-risk patients with only one or two risk factors may only need to use compressive stockings and begin walking early in the recovery period. High-risk patients, with four or more risk factors, may need mechanical compression of the calf and low-dose heparin as anticoagulation medication. However, only about one-third of patients with two or more risk factors actually receive prophylaxis. Use of effective preventive measures might avert from 4,000 to 8,000 postoperative deaths per year in the United States. Use of prophylaxis in hip replacement surgery patients has been found effective in saving both lives and money (the cost of treating thrombosis). Use of anticoagulants such as heparin carries with it the potential complication of bleeding. New low-molecular-weight heparins have been shown to reduce the risk of bleeding while maintaining the antithrombotic effect of regular heparin. Small daily doses of low-molecular-weight heparin, if the safety and effectiveness of this approach continue to be demonstrated, will probably be widely used in the future. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Innovations, Anticoagulants (Medicine), Anticoagulants, Heparin

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The asymptomatic patient with suspected myocardial contusion

Article Abstract:

Myocardial contusion (bruising of the muscle of the heart) places a patient at greater risk for abnormal heart rhythm and other serious and possibly fatal complications. Patients with suspected myocardial contusion (MCC) are treated very conservatively with close heart monitoring, but it has been reported that the incidence of serious complications is very small. Criteria for diagnosis and hospital admission for MCC are not clear. A review of patients with suspected MCC was undertaken to determine the incidence of complications, develop criteria for patient treatment, and to attempt to identify a high risk group that should be admitted to the hospital. During a 33-month period, 1,936 patients were admitted to the trauma service. There were 524 (27 percent) with suspected MCC, and 27 of these patients (5 percent) developed a total of 28 heart-related complications. There were 23 cases of dysrhythmia, three infarctions, and two pericardial effusions (fluid collection in the sac containing the heart). Four patients with suspected MCC had normal electrocardiograms (EKG), one of these patients developed abnormal heart rhythm four hours after hospital admission. In minimally injured patients, the incidence of heart-related complications was 0.1 percent. There were no complications in any patient with isolated chest wall bruises, and a normal EKG at admission and four hours later. It is concluded that hospital admission is not necessary for patients with minimal isolated chest wall bruises, and two normal EKGs within a period of four hours following injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diagnosis, Heart, Blunt trauma

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