Venous thromboembolism (VTE) and its complications are one of the banes of the trauma professional’s existence. Trauma centers have initiated extensive systems of risk assessment, screening, prophylaxis, and treatment of patients at risk for this problem. But typically, much of this management ends at or shortly after discharge from the hospital.
How long do we need to worry? Some trauma programs continue prophylaxis on at-risk patients until they are ambulating well, or for an arbitrary period of time, like one month. But until recently, we’ve had no guidance based on actual numbers. A California study may shed some light on this gray area.
A large dataset from a state of California hospital discharge database was massaged, looking at 6 years of data from patients at the highest risk for VTE (injuries of the pelvis, spine, and spinal cord). The authors looked forward in time after the initial discharge to see if there were any future admissions for VTE and its complications.
Here are the factoids:
- Patients with spinal cord injury had the highest risk of VTE, pelvic fractures were mid-range, and vertebral fractures the lowest risk.
- Occurrence of VTE was associated with a significant risk of mortality, but it was not possible to determine why.
- In all groups, the risk of VTE remained for the first 3 months after injury, then declined rapidly.
- VTE risk returned to the level of the general population after about 12 months in patients with pelvic and vertebral injuries.
- VTE risk in spinal cord injured patients followed a similar curve, but never completely returned to the population baseline.
Bottom line: Obviously, this is not a clinical study. But it’s size and duration is unprecedented and provides valuable information anyway. This information calls into question our existing treatment intervals for prevention of VTE. However, it does not provide real and actionable guidance yet. Additional clinical studies will be needed to parse out the best drugs and duration of treatment.
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Reference: Can we ever stop worrying about venous thromboembolism after trauma? J Trauma 78(3):475-481, 2015.
