Legacy Emanuel Medical Center, 2801 N. Gantenbein, Suite 130, Portland, OR 97227, USA.
Legacy Emanuel Medical Center, 2801 N. Gantenbein, Suite 130, Portland, OR 97227, USA.
Am J Surg. 2014 May;207(5):648-51; discussion 651-2. doi: 10.1016/j.amjsurg.2013.12.010. Epub 2014 Jan 30.
In trauma patients, Enoxaparin (a low molecular weight heparin, LMWH) prophylaxis for venous thromboembolism (VTE) risk reduction is unproven.
Cohort analysis conducted consisting of all trauma patients age >13 admitted to Level-I trauma center and hospitalized >48 hours. VTE risk determined by the Risk Assessment Profile. High risk patients received LMWH unless contraindicated, while low and moderate risk patients received LMWH at attending surgeon's discretion. Odds ratio for VTE by logistic regression. VTE incidence, relative risk (RR), and number needed to treat (NNT) to prevent deep vein thrombosis (DVT) or pulmonary embolism determined by risk category.
Cohort consisted of 2,281 patients (1,211 low, 979 moderate, 91 high risks). VTE occured in 254 patients (11.1%). High-risk patients had significantly higher VTE incidence, odds ratio = 31.8 (P < .001). VTE was significantly reduced in high-risk patients receiving LMWH versus those who did not (.26 vs .53, P = .02). Among moderate and high risk, prophylactic LMWH reduced the incidence of pulmonary embolism (RR = .19, NNT = 40.4, P = .01), and trended toward reduced DVT incidence (RR = .81, NNT = 27.3, P = .15). LMWH lowered DVT incidence (RR = .52, NNT = 4.1, P = .03) in high risk patients.
Prophylactic LMWH is associated with reduction of VTE in trauma patients.
在创伤患者中，依诺肝素（一种低分子肝素，LMWH）预防静脉血栓栓塞症（VTE）的效果尚未得到证实。
对所有年龄>13 岁、入住一级创伤中心且住院时间>48 小时的创伤患者进行队列分析。VTE 风险通过风险评估模型确定。高危患者除非有禁忌证，否则给予 LMWH 预防，而低危和中危患者则由主治医生决定是否给予 LMWH 预防。采用逻辑回归分析 VTE 的比值比。根据风险类别确定 VTE 发生率、相对风险（RR）和预防深静脉血栓形成（DVT）或肺栓塞的需要治疗人数（NNT）。
队列包括 2281 例患者（低危 1211 例，中危 979 例，高危 91 例）。254 例患者发生 VTE（11.1%）。高危患者 VTE 发生率显著更高，比值比=31.8（P<.001）。与未接受 LMWH 预防的患者相比，接受 LMWH 预防的高危患者 VTE 发生率显著降低（0.26 比 0.53，P=.02）。在中危和高危患者中，预防性 LMWH 降低了肺栓塞的发生率（RR=0.19，NNT=40.4，P=.01），且有降低 DVT 发生率的趋势（RR=0.81，NNT=27.3，P=.15）。LMWH 降低了高危患者的 DVT 发生率（RR=0.52，NNT=4.1，P=.03）。
预防性 LMWH 可降低创伤患者的 VTE 发生率。
