Venous Thromboembolic Prophylaxis A Trauma Surgeon's Perspective COA

Description: There are many venous thromboembolism risk factors in trauma. These include: spinal cord injury, pelvic and spine fractures, head trauma, femoral venous line or vascular repair, multiple operations, older age (greater than 50 years), immobility (greater than three days), and lower extremity fractures. "Lower extremity fractures" is vague, but there is increasing incidence of clot likelihood after injury to the hip and pelvis with diminishing incidence down to the ankle. The risk becomes high enough that we must use thromboembolic prophylaxis at the level of the tibial plateau. Tibial plateau fractures have venographic proven clots as much as 40% of the time in an occult group of non-prophylaxed patients. When there is a prolonged operating time of greater than 100 minutes, or delay from injury to open reduction of more than 27 hours, there is twice the risk of DVT.
Richard E. Buckley, M.D., FRCSC COA Bulletin Issue 83 2008