Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida (Mss Sanchez, Nguyen, Baroutjian, and Gill and Drs McKenney and Elkbuli); and Department of Surgery, University of South Florida, Tampa (Dr McKenney).
J Trauma Nurs. 2021;28(5):323-331. doi: 10.1097/JTN.0000000000000606.
Appropriate venous thromboembolism (VTE) chemoprophylaxis in trauma and emergency general surgery (EGS) patients is crucial.
The purpose of this study is to review the recent literature and offer recommendations for VTE chemoprophylaxis in trauma and EGS patients.
We conducted a literature search from 2000 to 2021 for articles investigating VTE chemoprophylaxis in adult trauma and EGS patients. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
Our search resulted in 34 articles. Most studies showed low-molecular-weight heparin (LMWH) is similar to unfractionated heparin (UFH) for VTE prevention; however, LMWH was more commonly used. Adjusted chemoprophylaxis dosing did not change the VTE rate but the timing did. Direct oral anticoagulants (DOACs) have been shown to be safe and effective in trauma and traumatic brain injury (TBI)/spinal cord injury (SCI). Studies showed VTE prophylaxis in EGS can be inconsistent and improves with guidelines that lower VTE events.
There may be no benefit to receiving LMWH over UFH in trauma patients. In addition, different drugs under the class of LMWH do not change the incidence of VTE. Adjusted dosing of enoxaparin does not seem to affect VTE incidence. The use of DOACs in the trauma TBI and SCI setting has been shown to be safe and effective in reducing VTE. One important consideration with VTE prophylaxis may be the timing of prophylaxis initiation, specifically as it relates to TBI, with a higher likelihood of developing VTE as time progresses. EGS patients are at a high risk of VTE. Improved compliance with clinical guidelines in this population is correlated with decreased thrombotic events.
在创伤和急诊普通外科（EGS）患者中，适当的静脉血栓栓塞（VTE）预防至关重要。
本研究旨在回顾近期文献，为创伤和 EGS 患者的 VTE 预防提供建议。
我们对 2000 年至 2021 年期间调查成人创伤和 EGS 患者 VTE 预防的文章进行了文献检索。本研究符合系统评价和荟萃分析的首选报告项目（PRISMA）指南。
我们的搜索结果为 34 篇文章。大多数研究表明，低分子肝素（LMWH）与未分级肝素（UFH）预防 VTE 相似，但 LMWH 更为常用。调整后的化学预防剂量并未改变 VTE 发生率，但改变了时机。直接口服抗凝剂（DOAC）已被证明在创伤和创伤性脑损伤（TBI）/脊髓损伤（SCI）中是安全有效的。研究表明，EGS 中的 VTE 预防可能不一致，并且遵循降低 VTE 事件的指南会有所改善。
创伤患者接受 LMWH 治疗可能无益于接受 UFH 治疗。此外，LMWH 类药物的不同药物不会改变 VTE 的发生率。依诺肝素的调整剂量似乎不会影响 VTE 的发生率。DOAC 在创伤 TBI 和 SCI 环境中的应用已被证明在降低 VTE 方面是安全有效的。VTE 预防的一个重要考虑因素可能是预防措施的启动时机，特别是与 TBI 相关的时机，随着时间的推移，VTE 发生的可能性更高。EGS 患者 VTE 风险高。在该人群中，提高对临床指南的依从性与血栓形成事件的减少相关。
