BACKGROUND

Trauma patients are at high risk for Venous Thromboembolism (VTE) including Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE). Trauma patients can have up to 58% incidence of DVT.1 Sevitt and Gallagher reported an even higher incidence (65%) in injured and burned patients and reported a 16.5% incidence of PE found at autopsy in this cohort of patients.2,3

In addition to the hypercoagulable state induced by severe injury in trauma, combat casualties have additional risk factors for DVT, including: 1,4-8

- Early transfusion of blood products (≤24 hours)
- Transfusion of old blood (≥28 days)
- Multiple and/or above the knee amputations
- Immobility/prolonged air transport time
- Traumatic brain injury (TBI)

The use of Fresh Frozen Plasma (FFP) outside of large volume blood product transfusion (less than 4 U PRBC’s) incurs an increased risk of VTE.9 Early prophylaxis in this patient population is recommended provided hemostasis has been achieved.

Our deployed medical teams need to be prepared to care for injured children in the combat environment. While the incidence of DVT in pediatric trauma is much lower (6.2%) than that of adults in the civilian literature,10 multiple risk factors including immobility and presence of central venous lines were associated with the development of DVT in pediatric trauma patients.

Prolonged airplane travel may also increase the occurrence of DVT, with one study noting a 10% prevalence of asymptomatic DVT in individuals undergoing flights of eight hours or more.11 Combat casualties will often undergo prolonged evacuation, with long flights and immobility further increasing their risk of VTE. Thus, it is important to start VTE prophylaxis as soon as clinically possible.12

Different medical societies and working groups have published varying recommendations for chemical VTE prophylaxis. 13-17 The recommended clinical guidelines are based on supporting scientific evidence and expert consensus input. It is recommended to begin chemical VTE prophylaxis therapy as soon as coagulopathy is corrected in patients without an increased risk of bleeding.