Knudson MM, Lewis FR, Clinton A, Atkinson K, Megerman J.
Prevention of venous thromboembolism in trauma patients.
J Trauma 1994 Sep;37(3):480-7

University of California, San Francisco.

Trauma patients are at risk for thromboembolic complications, but effective
methods of prophylaxis have not been established for this heterogenous
population. In this prospective trial, 400 trauma patients were assigned to one
of three groups, depending upon their injuries, and randomized within each group
to a treatment mode: Group I: sequential gradient pneumatic leg compression
(SCD), low-dose subcutaneous heparin (H), or control (C); Group II: H or C; Group
III: SCD or C. Venous duplex ultrasound examinations were performed on admission
and weekly thereafter. Of the 251 patients who completed the study, 15 (6%)
developed lower extremity venous thrombosis and two additional patients developed
pulmonary embolism (one fatal). Significant risk factors associated with the
development of thromboembolism included immobilization > 3 days, age 30 years or
older, and the presence of pelvic or lower extremity fractures. In patients with
neurotrauma who cannot receive heparin (Group III), the SCD was more effective
than control in preventing DVT (p = 0.057). Neither H nor SCD appeared to offer
protection for the other groups of trauma patients, but surveillance with
ultrasound examinations allowed for prompt recognition and treatment of occult
deep vein thrombosis.