Background: Deep-vein thrombosis following skeletal trauma is an
important yet poorly studied issue. The purpose of the present study was to
evaluate the efficacy of two different strategies for prophylaxis against
deep-vein thrombosis and pulmonary embolus following blunt skeletal
trauma.
Methods: Two hundred and twenty-four inpatients were enrolled in a
prospective, randomized study investigating venous thromboembolic disease
following trauma. Two hundred patients completed the study, which compared two
different regimens of prophylaxis. The patients in Group A received enoxaparin
(30 mg, administered subcutaneously twice a day) starting twenty-four to
forty-eight hours after blunt trauma. The patients in Group B were managed
with pulsatile foot pumps at the time of admission combined with enoxaparin on
a delayed basis. All patients were screened with magnetic resonance venography
and ultrasonography before discharge.
Results: There were ninety-seven patients in Group A and 103
patients in Group B. Twenty-two patients (including thirteen in Group A and
nine in Group B) had development of deep-vein thrombosis, with two (both in
Group A) also having development of pulmonary embolism. The prevalence of
deep-vein thrombosis was 11% for the whole series, 13.4% for Group A, and 8.7%
for Group B; the difference between Groups A and B was not significant. There
were eleven large or occlusive clots (prevalence, 11.3%) in Group A, compared
with only three (prevalence, 2.9%) in Group B (p = 0.025). The prevalence of
pulmonary embolism was 2.1% in Group A and 0% in Group B. Wound complications
occurred in twenty-one patients in Group A, compared with twenty patients in
Group B. Patients who had development of deep-vein thrombosis during the
inpatient portion of the study required a mean of 7.4 units of blood during
hospitalization, compared with 3.9 units of blood for those who did not (p
< 0.05).
Conclusions: Our results indicate that early mechanical prophylaxis
with foot pumps and the addition of enoxaparin on a delayed basis is a very
successful strategy for prophylaxis against venous thromboembolic disease
following serious musculoskeletal injury. The prevalence of large or occlusive
deep-vein thromboses among patients who had been managed with this protocol
was significantly less than that among patients who had been managed with
enoxaparin alone.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.