From the Guidelines
The actual name for DVT after trauma is "Post-traumatic Deep Vein Thrombosis." This condition occurs when a blood clot forms in a deep vein following physical trauma to the body. Post-traumatic DVT commonly develops in patients who have experienced significant injuries, particularly to the lower extremities, pelvis, or spine, or in those who have undergone surgical procedures. The risk is especially high when trauma results in immobilization, as blood flow becomes sluggish in the veins. Prevention typically involves early mobilization when possible, mechanical prophylaxis with compression devices, and pharmacological prophylaxis with anticoagulants such as low molecular weight heparin (enoxaparin 40mg subcutaneously once daily or 30mg twice daily) or fondaparinux (2.5mg subcutaneously once daily) 1. Treatment, once diagnosed, usually consists of therapeutic anticoagulation with either direct oral anticoagulants (DOACs) like rivaroxaban or apixaban, or traditional therapy with heparin followed by warfarin for at least 3 months. The development of post-traumatic DVT relates to Virchow's triad: venous stasis from immobility, endothelial injury from the trauma itself, and hypercoagulability that often follows major injury.
Key Points
- Post-traumatic DVT is a significant concern in patients with major trauma, with a high risk of pulmonary embolism and mortality 1.
- Prevention strategies include early mobilization, mechanical prophylaxis, and pharmacological prophylaxis with anticoagulants.
- The choice of anticoagulant depends on the patient's risk factors and bleeding risk, with low molecular weight heparin and fondaparinux being common options.
- Treatment of post-traumatic DVT typically involves therapeutic anticoagulation with DOACs or traditional therapy with heparin and warfarin.
Recommendations
- All patients with major trauma should be assessed for their risk of post-traumatic DVT and receive prophylaxis accordingly 1.
- Mechanical prophylaxis with compression devices should be used in patients with a high bleeding risk.
- Pharmacological prophylaxis with anticoagulants should be started as soon as possible after trauma, once the bleeding risk has been assessed.
- Treatment of post-traumatic DVT should be individualized based on the patient's risk factors and response to therapy.
From the Research
Definition and Terminology
- The actual name for DVT after trauma is Deep Vein Thrombosis (DVT) and Venous Thromboembolism (VTE) 2.
- VTE is a disease entity comprising DVT and pulmonary embolism (PE) 3.
Medical Understanding
- DVT and PE are major causes of hospital-related morbidity and mortality, and are recognized as complications in patients with traumatic injury 2.
- Anticoagulation is the mainstay of VTE treatment 4.
- Patients with traumatic injury are routinely treated with either mechanical or pharmacological treatments to prevent DVT 2.
Treatment Options
- Low-molecular-weight heparin (LMWH) is often used as initial antithrombotic therapy following DVT or PE 5.
- Direct-acting oral anticoagulants (DOACs) are an alternative to LMWH and vitamin K antagonists (VKAs) 3, 6.
- Thrombolytic therapy may be beneficial for hemodynamically unstable patients with a low bleeding risk 4, 5.
Patient Care
- Early identification and targeted VTE prophylaxis in trauma patients may prevent this life-threatening complication 2.
- Patients with objectively diagnosed DVT or PE should receive therapeutic anticoagulation for a minimum of 3 months 3, 4.
- Treatment of VTE is more challenging in specific patient groups, such as pregnant women, cancer patients, and elderly patients 3, 6.