Tran Alexandre, Lutsey Pamela L, Carrier Marc
Department of Critical Care, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
Haematologica. 2024 Dec 1;109(12):3860-3867. doi: 10.3324/haematol.2023.284612.
Trauma is an established risk factor for venous thromboembolism (VTE). Whether minor trauma is linked to greater risk of VTE remains unclear given that many studies evaluating trauma and VTE risk have not differentiated risk by trauma severity. Furthermore, the underlying risk of VTE is not uniform across all injured patients. While it is generally accepted that severely and moderately injured patients requiring prolonged hospitalization benefit from early and consistent administration of thromboprophylaxis, the threshold for its initiation following minor injury or in patients managed in an ambulatory setting is less clear. This review will describe how trauma is classified, summarize the evidence of the risk of VTE in patients with minor trauma, and guide clinicians through an approach to individualize these treatment decisions based on contemporary evidence. Guidance will be provided for both injured patients requiring hospitalization (who may have severe, moderate or minor trauma), and those suitable to be managed in an ambulatory setting (minor trauma).
创伤是静脉血栓栓塞症(VTE)的既定风险因素。鉴于许多评估创伤与VTE风险的研究并未按创伤严重程度区分风险,轻微创伤是否与更高的VTE风险相关仍不明确。此外,并非所有受伤患者发生VTE的潜在风险都是一致的。虽然普遍认为需要长期住院的重度和中度受伤患者可从早期持续进行血栓预防中获益,但对于轻伤患者或在门诊治疗的患者开始进行血栓预防的阈值尚不清楚。本综述将描述创伤如何分类,总结轻伤患者发生VTE风险的证据,并根据当代证据指导临床医生采用个体化方法做出这些治疗决策。将为需要住院治疗的受伤患者(可能有重度、中度或轻度创伤)以及适合在门诊治疗的患者(轻伤)提供指导。