Treatment of Venous Thromboembolism in Trauma Patients: Features and Possibilities

Keywords: deep vein thrombosis, pulmonary embolism, cava filters

Abstract

The aim. Treatment of venous thromboembolism continues to be one of the most controversial problems of modern angiology. This issue is especially relevant in the treatment of patients with traumatological pathology.

Methods. Treatment of 1915 patients with fractures of lower extremities from 2017 to 2022 at the Vinnytsia Regional Pyrohov Clinical Hospital was analyzed. During the study period, 727 (38%) deep vein thromboses were diagnosed.

Results. During the study period, 4 (0.2%) pulmonary embolisms were diagnosed, among which 3 (0.15%) were fatal.

In 99.5% of patients with venous thrombosis and injuries, it was possible to achieve clinical improvement and regression of the thrombotic process.

Conclusions. Treatment tactics for trauma patients with venous thromboembolism should be individualized and take into account the severity and localization of the injury, the need and urgency of trauma surgery, the risk of pulmonary embolism.

References

  1. He LX, Xie JY, Lv J, Liu H, Liao DB, Wang GL, et al. Quality evaluation of clinical practice guidelines for thromboprophylaxis in orthopaedic trauma based on AGREE II and AGREE-REX: a systematic review protocol. BMJ Open. 2022;12(11):e059181. https://doi.org/10.1136/bmjopen-2021-059181
  2. Rogers MA, Levine DA, Blumberg N, Flanders SA, Chopra V, Langa KM. Triggers of Hospitalization for Venous Thromboembolism. Circulation. 2012;125(17):2092-9. https://doi.org/10.1161/CIRCULATIONAHA.111.084467
  3. Barceló M, Torres OH, Mascaró J, Casademont J. Hip fracture and mortality: study of specific causes of death and risk factors. Arch Osteoporos. 2021;16(1):15. https://doi.org/10.1007/s11657-020-00873-7. Erratum in: Arch Osteoporos. 2021 Mar 4;16(1):53.
  4. Khrebtiy Y, Chernukha L. Is there a place for aggressive tactics in the treatment of deep vein thrombosis today? Clinical case of aspiration thrombectomy in the treatment of deep vein thrombosis. Acta Phlebol. 2021;22(2):61-8. https://doi.org/10.23736/S1593-232X.20.00476-2
  5. Chernuha LM, Skupii OM, Mitiuk OI, Khrebtiy YV. [Some Aspects of Treatment of Deep Venous Thrombosis of the Inferior Vena Cava System Complicated by Pulmonary Embolism – Opportunities and Outcomes]. Novosti Khirurgii. 2015;23(3):309-13. Russian. https://doi.org/10.18484/2305-0047.2015.3.309
  6. Khrebtiy YV. [An Integrated Approach to the Treatment of Pulmonary Embolism: Current State of the Problem]. Ukrainian Journal of Cardiovascular Surgery. 2022;30(2):39-43. Ukrainian. https://doi.org/10.30702/ujcvs/22.30(02)/Kh026-3943
  7. Ho KM, Rao S, Rittenhouse KJ, Rogers FB. Use of the Trauma Embolic Scoring System (TESS) to Predict Symptomatic Deep Vein Thrombosis and Fatal and Non- Fatal Pulmonary Embolism in Severely Injured Patients. Anaesth Intensive Care. 2014;42(6):709-14. https://doi.org/10.1177/0310057X1404200605
  8. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in Orthopedic Surgery Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e278S-e325S. https://doi.org/10.1378/chest.11-2404
  9. Li J, Zhu Y, Chen W, Zhao K, Zhang J, Meng H, et al. Incidence and locations of deep venous thrombosis of the lower extremity following surgeries of tibial plateau fractures: a prospective cohort study. J Orthop Surg Res. 2020;15(1):605. https://doi.org/10.1186/s13018-020-02136-0
  10. Sedani A, Yakkanti R, Allegra P, Mattingly L, Aiyer A. Thromboprophylaxis across orthopaedic surgery: Bibliometric analysis of the most cited articles. J Clin Orthop Trauma. 2021;16:157-67. https://doi. org/10.1016/j.jcot.2020.12.015. Erratum in: J Clin Orthop Trauma. 2021 Aug 05;21:101560.
  11. Yang W, Wei Q, Wang H, Ding K, Li M, Li C, et al. Preoperative incidence and risk factors of deep venous thrombosis in patients with isolated femoral shaft fracture. BMC Surg. 2022;22(1):83. https://doi.org/10.1186/s12893-022-01534-x
  12. Imura M, Yamamoto T, Hiasa KI. Pulmonary Thromboembolism Developed During Hospitalization: A Nationwide Retrospective Observational Study Using Claims Data. Cardiol Ther. 2022 Dec 8:1-15. https://doi.org/10.1007/s40119-022-00290-6. Epub ahead of print.
  13. Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt- Montoya S, Black SA, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9-82. https://doi.org/10.1016/j.ejvs.2020.09.023
  14. Ngarmukos S, Kim KI, Wongsak S, Chotanaphuti T, Inaba Y, Chen CF, et al.; Asia-Pacific (AP) Region Venous Thromboembolism (VTE) Consensus Group. Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 1. Diagnosis and risk factors. Knee Surg Relat Res. 2021;33(1):18. https://doi.org/10.1186/s43019-021-00099-y
  15. Canakci ME, Acar N, Bilgin M, Kuas C. Diagnostic value of point-of-care ultrasound in deep vein thrombosis in the emergency department. J Clin Ultrasound. 2020;48(9):527-31. https://doi.org/10.1002/jcu.22892.
  16. Erkens PM, Prins MH. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev. 2010;(9):CD001100. https://doi.org/10.1002/14651858.CD001100.pub3
  17. Prins MH, Lensing AW, Bauersachs R, van Bellen B, Bounameaux H, Brighton TA, et al.; EINSTEIN Investigators. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb J. 2013;11(1):21. https://doi.org/10.1186/1477-9560-11-21
  18. National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE guideline [NG89] [Internet]. Published: 2018 March 21 [updated: 2019 August 13; cited 2022 Dec 25]. Available from: www.nice.org.uk/guidance/ng89
  19. Pankratz C, Cintean R, Boitin D, Hofmann M, Dehner C, Gebhard F, et al. Early Surgical Care of Anticoagulated Hip Fracture Patients Is Feasible-A Retrospective Chart Review of Hip Fracture Patients Treated with Hip Arthroplasty within 24 Hours. J Clin Med. 2022;11(21):6570. https://doi.org/10.3390/jcm11216570
  20. Young T, Sriram KB. Vena caval filters for the prevention of pulmonary embolism. Cochrane Database Syst Rev. 2020;10(10):CD006212. https://doi.org/10.1002/14651858.CD006212.pub5
  21. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603. https://doi.org/10.1093/eurheartj/ehz405
  22. Ley EJ, Brown CVR, Moore EE, Sava JA, Peck K, Ciesla DJ, et al. Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2020;89(5):971-81. https://doi.org/10.1097/TA.0000000000002830
Published
2023-03-27
How to Cite
Khrebtiy, Y. V., Chernukha, L. M., Skupyy, O. M., Maiko, V. M., & Khrebtii, H. I. (2023). Treatment of Venous Thromboembolism in Trauma Patients: Features and Possibilities. Ukrainian Journal of Cardiovascular Surgery, 31(1), 74-79. https://doi.org/10.30702/ujcvs/23.31(01)/KhCh004-7479
Section
PERIPHERAL VASCULAR DISEASE PATHOLOGY