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Evidence summaries

Thromboprophylaxis for Trauma Patients

Use of thromboprophylaxis may prevent deep vein thrombosis in severe trauma patients. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (unclear allocation concealment), and by imprecise results (few outcome events).

Summary

A Cochrane review [Abstract] 1 included 16 studies with a total of 3 005 subjects. Thromboprophylaxis did not reduce the primary outcome mortality or the secondary outcome pulmonary embolism (PE) but prophylaxis reduced the risk of deep vein thrombosis (DVT) in people with major trauma. Pharmacological prophylaxis was more effective than mechanical methods. Pharmacological prophylaxis increased the risk of bleeding (RR 2.04, 95% CI 1.08 to 3.86; 5 studies, n=953) compared to mechanical methods. People who received both mechanical and pharmacological prophylaxis had a lower risk of DVT than those receiving only pharmacological prophylaxis. LMWH appeared to reduce the risk of DVT compared to unfractionated heparin (UH) (RR 0.68, 95% CI 0.50 to 0.94; 2 studies, n=331). There was no statistically significant difference in the risk of bleeding between LMWH and UH. Comparison between pharmacological prophylaxis against placebo was not possible due to lack of studies.

Comparison/OutcomeParticipants (studies)RR (95% CI)
Any type (mechanical and/or pharmacological) prophylaxis vs. no prophylaxis
DVT997 (4)0.52 (0.32 to 0.84)
PE997 (4)0.65 (0.29 to 1.43)
Mortality997 (4)0.59 (0.20 to 1.70)
Mechanical prophylaxis vs. no prophylaxis
DVT907 (5)0.55 (0.34 to 0.90)
PE907 (5)0.77 (0.36 to 1.66)
Mortality907 (5)0.74 (0.27 to 2.04)
Pharmacological prophylaxis vs. mechanical prophylaxis
DVT1033 (6)0.48 (0.25 to 0.95)
PE1033 (6)0.94 (0.36 to 2.42)
Mortality1033 (6)1.50 (0.44 to 5.16)
Mechanical + pharmacological prophylaxis vs. pharmacological
DVT507 (3)0.34 (0.19 to 0.60)
PE507 (3)0.32 (0.05 to 2.01)
Mortality507 (3)0.50 (0.05 to 5.30)

Clinical comments

Note

Date of latest search:

    References

    • Barrera LM, Perel P, Ker K et al. Thromboprophylaxis for trauma patients. Cochrane Database Syst Rev 2013;(3):CD008303. [PubMed]

Primary/Secondary Keywords