Thromboprophylaxis for Trauma Patients

This week, as part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on thromboprophylaxis for trauma patients that was selected for the TREKK Evidence Repository on Multiple Trauma.

Key Messages:

Week 1 Blogshot_Multiple Trauma_Thromboprophylaxis

Related TREKK Resources:

Cochrane summary:

Preventing death from blood clots, the formation of blood clots and blood clots in the lungs in people who have had physical trauma

Thromboembolism (unwanted clotting of the blood) is a frequent complication in people who have experienced physical trauma and is also an important cause of death. The type of trauma, association with vascular injuries, and prolonged hospital bed rest are known risk factors for the development of deep vein thrombus (clot in veins of lower extremities) that can travel (embolize) to the lungs and cause death. Because of this it is usually recommended that people who have had major trauma are given mechanical or pharmacological treatments to prevent their blood forming unwanted blood clots. Mechanical interventions can include compression stockings, an air-filled plastic tube that presses around the leg, a metal blood clot filter placed inside a vein; pharmaceutical drugs include unfractionated heparin, low weight molecular heparin, anticoagulants (e.g. warfarin), antiplatelet drugs (e.g. aspirin) and others. Sixteen studies involving 3,005 people are included in this review. We did not find strong evidence that either mechanical or pharmacological interventions reduce death or clots travelling to the lungs, but we found some evidence that they can prevent clots from forming in the legs.

Authors’ conclusions:

We did not find evidence that thromboprophylaxis reduces mortality or pulmonary embolism in any of the comparisons assessed. However, we found some evidence that thromboprophylaxis prevents deep vein thrombosis (DVT). Although the strength of the evidence was not high, taking into account existing information from other related conditions such as surgery, we recommend the use of any DVT prophylactic method for people with severe trauma.

Check out the full Cochrane systematic review below:

Barrera, L.M., Perel, P., Ker, K., Cirocchi, R., Farinella, E., Morales Uribe, C.H. (2013). Thromboprophylaxis for trauma patients. Cochrane Database Syst Rev, 3, CD008303. doi: 10.1002/14651858.CD008303.pub2

_________________________________________________________________

This post is part of a weekly blog series highlighting pediatric emergency medicine (PEM) focused Cochrane summaries and other key resources selected by TREKK.

Published by arrangement with John Wiley & Sons.