This Article Full Text Full Text (PDF) CME: Take the activities for this article: Adult Hip Reconstruction Test 19: Spring 2006 (publication date May 15, 200... Adult Knee Reconstruction Test 11: Spring 2006 (publication date May 15, 20... CME 1: January, February, March 2006 [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stannard, J. P. Articles by Alonso, J. E. Search for Related Content PubMed PubMed Citation Articles by Stannard, J. P. Articles by Alonso, J. E. Related Collections Adult Hip Adult Knee Social Bookmarking                   What's this?

Prophylaxis Against Deep-Vein Thrombosis Following Trauma: A Prospective, Randomized Comparison of Mechanical and Pharmacologic Prophylaxis

¹ Division of Orthopaedic Surgery, University of Alabama at Birmingham, 509 Medical Education Building, 619 South 19th Street, Birmingham, AL 35294-3295. E-mail address for J.P. Stannard: james.stannard{at}ortho.uab.edu

Investigation performed at the University of Alabama at Birmingham, Birmingham, Alabama

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Aventis Pharmaceutical Grant-in-Aid (J.P.S., Principal Investigator; J.E.A., D.A.V., and R.R.L.-B., Co-Primary Investigators). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: Two hundred and twenty-four inpatients were enrolled in a prospective, randomized study investigating venous thromboembolic disease following trauma. Two hundred patients completed the study, which compared two different regimens of prophylaxis. The patients in Group A received enoxaparin (30 mg, administered subcutaneously twice a day) starting twenty-four to forty-eight hours after blunt trauma. The patients in Group B were managed with pulsatile foot pumps at the time of admission combined with enoxaparin on a delayed basis. All patients were screened with magnetic resonance venography and ultrasonography before discharge.

Results: There were ninety-seven patients in Group A and 103 patients in Group B. Twenty-two patients (including thirteen in Group A and nine in Group B) had development of deep-vein thrombosis, with two (both in Group A) also having development of pulmonary embolism. The prevalence of deep-vein thrombosis was 11% for the whole series, 13.4% for Group A, and 8.7% for Group B; the difference between Groups A and B was not significant. There were eleven large or occlusive clots (prevalence, 11.3%) in Group A, compared with only three (prevalence, 2.9%) in Group B (p = 0.025). The prevalence of pulmonary embolism was 2.1% in Group A and 0% in Group B. Wound complications occurred in twenty-one patients in Group A, compared with twenty patients in Group B. Patients who had development of deep-vein thrombosis during the inpatient portion of the study required a mean of 7.4 units of blood during hospitalization, compared with 3.9 units of blood for those who did not (p < 0.05).

Conclusions: Our results indicate that early mechanical prophylaxis with foot pumps and the addition of enoxaparin on a delayed basis is a very successful strategy for prophylaxis against venous thromboembolic disease following serious musculoskeletal injury. The prevalence of large or occlusive deep-vein thromboses among patients who had been managed with this protocol was significantly less than that among patients who had been managed with enoxaparin alone.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Facebook    Technorati    Twitter    What's this?

This article has been cited by other articles:

				W. H. Geerts, D. Bergqvist, G. F. Pineo, J. A. Heit, C. M. Samama, M. R. Lassen, and C. W. Colwell Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 381S - 453S. [Abstract] [Full Text] [PDF]

				T. Riordan Human Infection with Fusobacterium necrophorum (Necrobacillosis), with a Focus on Lemierre's Syndrome Clin. Microbiol. Rev., October 1, 2007; 20(4): 622 - 659. [Abstract] [Full Text] [PDF]

				Prevention of Venous Thromboembolism in Trauma Patients Journal Watch (General), March 10, 2006; 2006(310): 1 - 1. [Full Text]

				W. H. Geerts Prevention of Venous Thromboembolism in High-Risk Patients Hematology, January 1, 2006; 2006(1): 462 - 466. [Abstract] [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2006 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.