Background: Venous thromboembolism (VTE) is a common life-threatening complication of major trauma. Although clinical guidelines clearly suggest routine VTE prevention with low-molecular-weight heparin (LMWH) in this specific group of patients, there is still a lack of strong recommendations regarding the timing and the modality of heparin administration and the role of mechanical prophylaxis. We tested the hypothesis that there is significant practice variation in thromboprophylaxis management of patients with major trauma among intensive care unit (ICU) specialists. Methods: Two hundred Italian ICU specialists, representing 200 ICU throughout the country, were contacted by telephone and were asked (1) whether they routinely prescribe pharmacological antithrombotic prophylaxis in patients with major trauma, whether prophylaxis is prescribed to all patients or to selected patients, and the type of prophylaxis and the timing of administration and (2) whether they recommend physical prevention, whether this is prescribed to all patients or to selected patients, and the type of physical prophylaxis. Results: In patients with major trauma, 85% of the interviewed ICU specialists answered that they prescribe pharmacological prophylaxis for VTE. 37.6% of them prescribe prophylaxis only to selected patients based on the level of risk, 87.7% prescribe low-molecular-weight heparin, and 42.4% start prophylaxis immediately after hospitalization. Only 61% of the interviewed specialists prescribe physical prophylaxis; 82.8% of them use elastic stockings, 9.8% intermittent pneumatic compression, and 7.4% other mechanical devices. Physical prophylaxis is prescribed to all patients by 41%, and by 59% only in case of contraindication to pharmacological prevention. Inferior vena cava (IVC) filter insertion is considered by 47% when anticoagulation is contraindicated; 91.4% of them recommend the IVC filter only if deep vein thrombosis (DVT) has been diagnosed. Conclusions: Even when there are clinical guidelines, prescription of VTE prevention in patients with major trauma is underused and timing and modality of prophylaxis are rather heterogeneous. When anticoagulation is contraindicated, IVC filters are commonly recommended only in the presence of DVT.

This content is only available via PDF.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.