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Volume 331:1601-1606 December 15, 1994 Number 24 Next

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ABSTRACT

Background Although deep-vein thrombosis and pulmonary embolism are considered common complications after major trauma, their frequency and the associated risk factors have not been carefully quantified.

Methods We performed serial impedance plethysmography and lower-extremity contrast venography to detect deep-vein thrombosis in a cohort of 716 patients admitted to a regional trauma unit. Prophylaxis against thromboembolism was not used.

Results Deep-vein thrombosis in the lower extremities was found in 201 of the 349 patients (58 percent) with adequate venographic studies, and proximal-vein thrombosis was found in 63 (18 percent). Three patients died of massive pulmonary embolism before venography could be performed. Before venography, only three of the patients with deep-vein thrombosis had clinical features suggestive of the condition. Deep-vein thrombosis was found in 65 of the 129 patients with major injuries involving the face, chest, or abdomen (50 percent); in 49 of the 91 patients with major head injuries (54 percent); in 41 of the 66 with spinal injuries (62 percent); and in 126 of the 182 with lower-extremity orthopedic injuries (69 percent). Thrombi were detected in 61 of the 100 patients with pelvic fractures (61 percent), in 59 of the 74 with femoral fractures (80 percent), and in 66 of the 86 with tibial fractures (77 percent). A multivariate analysis identified five independent risk factors for deep-vein thrombosis: older age (odds ratio, 1.05 per year of age; 95 percent confidence interval, 1.03 to 1.06), blood transfusion (odds ratio, 1.74; 95 percent confidence interval, 1.03 to 2.93), surgery (odds ratio, 2.30; 95 percent confidence interval, 1.08 to 4.89), fracture of the femur or tibia (odds ratio, 4.82; 95 percent confidence interval, 2.79 to 8.33), and spinal cord injury (odds ratio, 8.59; 95 percent confidence interval, 2.92 to 25.28).

Conclusions Venous thromboembolism is a common complication in patients with major trauma, and effective, safe prophylactic regimens are needed.

Source Information

From the Departments of Medicine (W.H.G., K.I.C., R.M.J.) and Research Design and Biostatistics (J.P.S.) and the Clinical Epidemiology Unit (W.H.G., E.C., J.P.S.), Sunnybrook Health Science Centre, University of Toronto, Toronto.

Address reprint requests to Dr. Geerts at Sunnybrook Health Science Centre, Rm. D674, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada.

Full Text of this Article

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Thromboembolism after Major Trauma
Blebea J., Strothman G., Wells P., Anderson D. R., Geerts W. H., Jay R. M.
Extract | Full Text  
N Engl J Med 1995; 332:1448-1450, May 25, 1995. Correspondence

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• Spahn, D. R., Rossaint, R. (2005). Coagulopathy and blood component transfusion in trauma. Br J Anaesth 95: 130-139 [Abstract] [Full Text]  
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• Anderson, J. T., Owings, J. T., Goodnight, J. E. (1999). Bedside Noninvasive Detection of Acute Pulmonary Embolism in Critically Ill Surgical Patients. Arch Surg 134: 869-875 [Abstract] [Full Text]  
• Fisher, E. S., Welch, H. G. (1999). Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse?. JAMA 281: 446-453 [Abstract] [Full Text]  
• Verstraete, M. (1999). Prevention and treatment of venous thromboembolism after major trauma. Trauma 1: 39-51 [Abstract]  
• Kahn, S. R. (1998). The Clinical Diagnosis of Deep Venous Thrombosis: Integrating Incidence, Risk Factors, and Symptoms and Signs. Arch Intern Med 158: 2315-2323 [Abstract] [Full Text]  
• Yan, S.-F., Zou, Y. S., Gao, Y., Zhai, C., Mackman, N., Lee, S. L., Milbrandt, J., Pinsky, D., Kisiel, W., Stern, D. (1998). Tissue factor transcription driven by Egr-1 is a critical mechanism of murine pulmonary fibrin deposition in hypoxia. Proc. Natl. Acad. Sci. USA 95: 8298-8303 [Abstract] [Full Text]  
• Weitz, J. I. (1997). Low-Molecular-Weight Heparins. NEJM 337: 688-699 [Full Text]  
• Owings, J. T., Kraut, E., Battistella, F., Cornelius, J. T., O'Malley, R. (1997). Timing of the Occurrence of Pulmonary Embolism in Trauma Patients. Arch Surg 132: 862-867 [Abstract]  
• Killewich, L. A., Aswad, M. A., Sandager, G. P., Lilly, M. P., Flinn, W. R. (1997). A Randomized, Prospective Trial of Deep Venous Thrombosis Prophylaxis in Aortic Surgery. Arch Surg 132: 499-504 [Abstract]  
• Sharma, V., Howes, J., Cohen, A. T. (1997). Prospective Surveillance for Perioperative Venous Thrombosis. Arch Surg 132: 212-212 [Abstract]  
• Owings, J. T., Blaisdell, F. W. (1996). Low-Dose Heparin Thromboembolism Prophylaxis. Arch Surg 131: 1069-1073 [Abstract]  
• Geerts, W. H., Jay, R. M., Code, K. I., Chen, E., Szalai, J. P., Saibil, E. A., Hamilton, P. A. (1996). A Comparison of Low-Dose Heparin with Low-Molecular-Weight Heparin as Prophylaxis against Venous Thromboembolism after Major Trauma. NEJM 335: 701-707 [Abstract] [Full Text]  
• Prandoni, P., Goldhaber, S. Z., Piccioli, A., Girolami, A. (1996). State-of-the-Art Review : Prevention of Venous Thromboembolism in Major Orthopedic Surgery. CLIN APPL THROMB HEMOST 2: 153-157 [Abstract]  
• Flinn, W. R., Sandager, G. P., Silva, M. B. Jr, Benjamin, M. E., Cerullo, L. J., Taylor, M. (1996). Prospective Surveillance for Perioperative Venous Thrombosis: Experience in 2643 Patients. Arch Surg 131: 472-480 [Abstract]  
• Blebea, J., Strothman, G., Wells, P., Anderson, D. R., Geerts, W. H., Jay, R. M. (1995). Thromboembolism after Major Trauma. NEJM 332: 1448-1450 [Full Text]  
• (1994). TRAUMA PATIENTS HAVE A HIGH LIKELIHOOD OF DVT. JWatch General 1994: 1-1 [Full Text]