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Review
. 2020 Nov-Dec;11(6):1002-1008.
doi: 10.1016/j.jcot.2020.09.011. Epub 2020 Sep 16.

Guidelines for the prevention of venous thromboembolism in hospitalized patients with pelvi-acetabular trauma

Sameer Aggarwal  1 , Sandeep Patel  1 , Saurabh Vashisht  1 , Vishal Kumar  1 , Inderpaul Singh Sehgal  2 , Rajeev Chauhan  3 , Dr Sreedhara B Chaluvashetty  4 , Dr K Hemanth Kumar  5 , Dr Karan Jindal  1
Affiliations
Review

Guidelines for the prevention of venous thromboembolism in hospitalized patients with pelvi-acetabular trauma

Sameer Aggarwal et al. J Clin Orthop Trauma. 2020 Nov-Dec.

Abstract

Background: Venous thromboembolism is a dreaded complication leading to increased morbidity and mortality in patients having pelvi-acetabular fractures.

Objectives: These evidence based guidelines aim to provide the decision making ability in the prevention of venous thromboembolism in patients with pelvi-acetabular trauma planned for operative or non operative treatment.

Methods: The patients were subclassified into 5 categories. The PICO framework was used to devise research questions in each category. The systematic reviews were performed for each research question. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess outcomes of critical interest. The guideline panel consisting of expert members of different subspecialties, analyzed the evidence and made recommendations.

Results: The guideline panel proposed 21 recommendations. There are five recommendations in category 1 to 3, two recommendations in category 4 and four recommendations in category 5.

Conclusion: In pelvi-acetabular fractures there is strong evidence to suggest that thromboprophylaxis should be given. It should be initiated as early as possible after control of hemorrhage. The chemical prophylaxis is the preferred mode and LMWH is the preferred agent of choice. The mechanical methods can be used as an adjunct. The routine prophylactic use of IVC filters is not recommended. However, the use of retrievable IVC filters in high risk patients with established VTE in preoperative period can be considered. The use of newer directly acting oral anticoagulants is gaining importance.

Keywords: Deep vein thrombosis; Pelvi-acetabular; Pulmonary embolism; Thromboprophylaxis; Trauma; Venous thromboembolism.

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References

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Further reading

    1. Hamidi M., Zeeshan M., Sakran J.V. Direct oral anticoagulants vs low-molecular-weight heparin for thromboprophylaxis in nonoperative pelvic fractures. J Am Coll Surg. 2019;228(1):89–97. doi: 10.1016/j.jamcollsurg.2018.09.023. - DOI - PubMed
    1. Jehan F., O’Keeffe T., Khan M. Early thromboprophylaxis with low-molecular-weight heparin is safe in patients with pelvic fracture managed nonoperatively. J Surg Res. 2017;219:360–365. doi: 10.1016/j.jss.2017.06.049. - DOI - PubMed
    1. Falck-Ytter Y., Francis C.W., Johanson N.A. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e278S–e325S. doi: 10.1378/chest.11-2404. - DOI - PMC - PubMed
    1. Ricci W.M., Broekhuyse H., Keating J.F., Teague D.C., White T.O. Thromboprophylaxis an update of current practice: can we reach a consensus? OTA International. 2019;2(4):e027. doi: 10.1097/OI9.0000000000000027. - DOI - PMC - PubMed
    1. Fishmann A.J., Greeno R.A., Brooks L.R., Matta J.M. Prevention of deep vein thrombosis and pulmonary embolism in acetabular and pelvic fracture surgery. Clin Orthop Relat Res. 1994;305:133–137. - PubMed