Thromboprophylaxis following major skeletal trauma: a systematic review

Background: Thromboprophylaxis after injury is a controversial issue. Practices and outcomes vary widely. Methods: Review of selected trauma literature on venous thromboprophylaxis after injury. Results: Multiple trauma articles suggest that the efficacy of different methods of thromboprophylaxis is unproven. Most of the practices on this issue are extrapolated from studies which were performed in non-trauma patients and therefore, may not be applicable in the unique trauma population. Conclusions: In the absence of undisputable evidence, none of the current methods of venous thromboprophylaxis after injury should be considered as standard of care. There is a need to discover new methods of thromboprophylaxis for the Trauma patient. Despitedecades of research, the optimal method of prophylaxis against venous thromboembolism (VT) after trauma is not known. The complexity of the body?s response to injury is in part to blame for our failure to understand how to prevent life-threatening venous clots from forming. Cessation of bleeding depends on the induction of a prothrombotic stage after injury, clearly an evolutionary characteristic with major survival benefits. Its downside is VT. Preventing deep venous thrombosis (DVT) and pulmonary embolism (PE) without interrupting the ability to seal bleeding vessels presents a formidable challenge to trauma surgeons. Experts listed DVT/PE prophylaxis after trauma as the 5th most important research question that