ST. LUKE'S ROOSEVELT HOSPITAL CENTER
DEPARTMENT OF SURGERY
TRAUMA SERVICE
PRACTICE MANAGEMENT GUIDELINES
VENOUS THROMBOEMBOLISM IN TRAUMA
1. HIGH RISK PATIENTS:





MAJOR OPERATIVE PROCEDURE
VENOUS INJURY
VENTILATOR DAYS >3
SPINAL CORD INJURIES OR VERTEBRAL FRACTURES
2 OR MORE MODERATE RISK FACTORS
2. MODERATE RISK PATIENTS





AGE GREATER THAN 40 YEARS OF AGE
HEAD INJURY (AIS > 3)
PELVIC FRACTURE
LOWER EXTREMITY FRACTURE (AIS > 3)
SHOCK
3. LOW RISK PATIENTS

ALL PATIENTS WITH INJURIES NOT DELINEATED IN HIGH
AND MODERATE RISK CATEGORIES
GUIDELINE FOR MANAGEMENT OF VENOUS THROMBOEMBOLISM IN
TRAUMA PATIENTS
HIGH RISK PATIENTS WITHOUT CONTRAINDICATION TO ANTICOAGULATION
SHOULD RECEIVE LOW MOLECULAR WEIGHT HEPARIN -ENOXAPARIN 30 MG SC,
Q12 H - WITHIN 48 HOURS OF HOSPITAL ADMISSION

ALL PATIENTS IN THIS CATEGORY SHOULD RECEIVE WEEKLY COLOR
FLOW DOPPLER IMAGING (CFDI)
 IF LOW MOLECULAR WEIGHT HEPARIN IS CONTRAINDICATED,
MECHANICAL COMPRESSION SHOULD BE INITIATED AND EARLY CFDI
OBTAINED
 TEMPORARY IVC FILTER MAY BE CONSIDERED IN HIGH RISK PATIENTS
WITH CONTRAINDICATIONS TO PHARMACOLOGIC PROPHYLAXIS THAT
PERSIST BEYOND 4 DAYS
 CONTRAINDICATIONS TO ANTICOAGULATION MAY INCLUDE THE
FOLLOWING DIAGNOSIS/CONDITIONS
 INCOMPLETE SPINAL CORD INJURIES
 INTRAOCULAR INJURIES
 INTRACRANIAL HEMORRHAGE
 PELVIS OR LOWER EXTREMITY INJURIES WITH HEMORRHAGE.
 INTRABDOMINAL SOLID ORGAN INJURIES MANAGED NONOPERATIVELY
 THERE IS NO CLINICAL EVIDENCE SUPPORTING THE USE OF
UNFRACTIONATED HEPARIN IN THE REDUCTION OF DEEP VENOUS
THROMBOEMBOLISM IN TRAUMA PATIENTS.
TRAUMA/GUIDELINES/ THROMBOEMB GUIDE 2004 APPROVED 03/31/08
ST. LUKE'S ROOSEVELT HOSPITAL CENTER
DEPARTMENT OF SURGERY
TRAUMA SERVICE
PRACTICE MANAGEMENT GUIDELINES
VENOUS THROMBOEMBOLISM IN TRAUMA
MODERATE RISK PATIENTS: LOW MOLECULAR WEIGHT HEPARIN (ENOXAPARIN
30 MG. SC Q 12 H) IS STRONGLY RECOMMENDED IF NO CONTRAINDICATIONS
EXIST (SEE CONTRAINDICATIONS TO ANTICOAGULATION HIGH RISK PATIENTS).


IF A CONTRAINDICATION TO LOW MOLECULAR WEIGHT HEPARIN EXISTS
MECHANICAL COMPRESSION SHOULD BE INITIATED
WEEKLY CFDI RECOMMENDED IN PATIENTS NOT RECEIVING
PHARMACOLOGIC PROPHYLAXIS
LOW RISK PATIENTS: SEQUENTIAL COMPRESSION DEVICES SHOULD BE PLACED
IF FEASIBLE.

WEEKLY CFDI RECOMMENDED FOR ALL TRAUMA PATIENTS WITH
PROLONGED BED REST (> 5 DAYS)
REFERENCES:
Geerts, MD., William, H, Jay, MD., Richard M., Code, RN, Karen, Chen MB, MPH, Erluco, Szalai, PhD.,
John Paul, Saibil, MD., Eric A., Hamilton, MD., Paul A./A Comparison of Low-Dose Heparin with LowMolecular-Weight Heparin as Prophylaxis against Venous Thromboembolism after Major Trauma. N Engl J
Med 1996;335:701-7.
Link to reference: LMWH versus Unfractionated Heparin DVT Proph
Knudson, MD., FACS, M. Margaret, Ikossi, MD., Dangara G., Khaw, BA, Linda, Morabito RN, MPH, Diane,
Speetzen BA, Larisa S./ Thromboembolism after Trauma, An Analysis of 1602 Episodes from the American College of
Surgeons National Trauma Data Bank. Annals of Surgery 2004; 240:490-498.
Link to reference: Thromboembolism after Trauma NTDB Study.pdf
Nathens, MD, PhD, MPH, Avery B., McMurray, PharmD, Megan K., Cuschieri, MD., Joseph, Durr, PharmD, Emily
A., Moore, MD., Ernest E., Bankey, MD., Paul E., Freeman, MD., Brad, Harbrecht, MD., Brian G., Johnson, MD.,
Jeffrey L., Minei, MD., Joseph P., McKinley, MD., Bruce A., Moore, MD., Frederick A., Shapiro, MD., Michael B.,
West, MD., PhD., Michael A., Tompkins, MD., Ronald G., Maier, MD., Ronald V. The Practice of Venous
Thromboembolism Prophylaxis in the Major Trauma Patient. J Trauma 2007;62:557-533.
Link to reference: Trauma DVT Study.pdf
Norwood, MD, Scott H., McAuley, MD, Clyde E., Berne, MD, John D., Vallina, MD, Van L., Kerns, MD, D. Brent,
Grahm, MD, Thomas W., Short, MD., Kevin, McLarty, PhD., Jerry W./ Prospective Evaluation of the Safety of
Enoxaparin Prophylaxis with Intracranial Hemorrhagic Injuries. Arch Surg 2002;137:696-702. Available at
www.archsurg.com .
Link to reference: TBI Enoxaparin.pdf
EASTERN ASSOCIATION FOR THE SURGERY OF TRAUMA
Link to reference: http://www.east.org/tpg.asp
TRAUMA/GUIDELINES/ THROMBOEMB GUIDE 2004 APPROVED 03/31/08