Norwood S H, McAuley C E, Berne J D, Vallina V L, Kerns D B, Grahm T W, McLarty J W
Trauma and Neurosurgical Services, East Texas Medical Center, University of Texas Health Center, Tyler, USA.
J Am Coll Surg. 2001 Feb;192(2):161-7. doi: 10.1016/s1072-7515(00)00802-4.
Venous thromboembolism (VTE) is a frequent and potentially life-threatening complication after trauma. The purpose of this study is to investigate the effectiveness of enoxaparin in preventing deep venous thrombosis (DVT) and pulmonary embolism (PE) after injury in patients who are at high risk for developing VTE.
A prospective single-cohort observational study was initiated for seriously injured blunt trauma patients admitted to a Level I trauma center during a 7-month period. Patients were eligible for the study if time hospitalized was > or = 72 hours, Injury Severity Score (ISS) was > or = 9, enoxaparin was started within 24 hours after admission, and one or more of the following high risk criteria were met: age > 50 years, ISS > or = 16, presence of a femoral vein catheter, Abbreviated Injury Score (AIS) > or = 3 for any body region, Glasgow Coma Scale (GCS) Score < or = 8, presence of major pelvic, femur, or tibia fracture, and presence of direct blunt mechanism venous injury. Patients with closed head injuries and nonoperatively treated solid abdominal organ injuries were also potential participants. The primary outcomes measured were thromboembolic events--either a documented lower extremity DVT by duplex color-flow doppler ultrasonography or a PE documented by rapid infusion CT pulmonary angiography or conventional pulmonary angiography.
There were 118 patients enrolled in the study. Two patients (2%) developed DVT, one of which was proximal to the calf (95% confidence interval, 0% to 6%). Two of 12 patients (17%) with splenic injuries who received enoxaparin failed initial nonoperative management. There were no other bleeding complications, and no clinical evidence or documented episodes of PE. One patient died from multiple system organ failure.
Enoxaparin is a practical and effective method for reducing the incidence of VTE in high risk, seriously injured patients. This study supports further investigation into the safety of enoxaparin prophylaxis in patients with closed head injuries and nonoperatively treated solid abdominal organ injuries.
静脉血栓栓塞症（VTE）是创伤后常见且可能危及生命的并发症。本研究旨在探讨依诺肝素在预防有发生VTE高风险的创伤患者受伤后深静脉血栓形成（DVT）和肺栓塞（PE）方面的有效性。
对一家一级创伤中心在7个月期间收治的严重钝性创伤患者开展了一项前瞻性单队列观察性研究。如果住院时间≥72小时、损伤严重度评分（ISS）≥9、入院后24小时内开始使用依诺肝素，且符合以下一项或多项高风险标准，则患者符合研究条件：年龄>50岁、ISS≥16、存在股静脉导管、任何身体部位的简明损伤评分（AIS）≥3、格拉斯哥昏迷量表（GCS）评分≤8、存在骨盆、股骨或胫骨主要骨折，以及存在直接钝性机制导致的静脉损伤。闭合性颅脑损伤患者和非手术治疗的实性腹部器官损伤患者也是潜在参与者。所测量的主要结局是血栓栓塞事件——通过双功彩色血流多普勒超声检查记录的下肢DVT，或通过快速注射CT肺动脉造影或传统肺动脉造影记录的PE。
118例患者纳入研究。2例患者（2%）发生DVT，其中1例位于小腿近端（95%置信区间，0%至6%）。12例接受依诺肝素治疗的脾损伤患者中有2例（17%）初始非手术治疗失败。无其他出血并发症，也无PE的临床证据或记录事件。1例患者死于多系统器官衰竭。
依诺肝素是降低高风险、严重受伤患者VTE发生率的一种实用且有效的方法。本研究支持进一步调查依诺肝素预防对闭合性颅脑损伤患者和非手术治疗的实性腹部器官损伤患者的安全性。
