Complications related to deep venous thrombosis prophylaxis in trauma: a systematic review of the literature

Multisystem traumatic injury is a significant risk factor for the development of a deep venous thrombosis (DVT). Without thromboprophylaxis, overall DVT rates exceed 50% [1-3]. Although DVT alone is not life-threatening, a resulting pulmonary embolism (PE) carries potentially significant morbidity and mortality. PE is estimated to be the third leading cause of death in injured patients who survive beyond the first day of admission [2,4-6]. Trauma patients at the highest risk have been identified as those with a lower extremity or pelvic fracture, spinal cord injury, brain injury (Glasgow Coma Score < 8), increased age, surgical intervention, femoral central venous catheter, and prolonged immobilization [2,3,7-9].Modalities available for trauma patient thromboprophylaxis are classified into pharmacologic anticoagulation, mechanical compression devices, and inferior vena cava (IVC) filtration. Although the options are numerous, level one evidence currently supports the use of pharmacologic anticoagulation with low molecular weight heparins (LMWHs) as the primary DVT prophylactic agent [10]. Other modalities such as mechanical compression devices and IVC filters are not used for primary thromboprophylaxis, but may be helpful when LMWHs are contraindicated. This systematic review describes the potential complications associated with LMWHs, mechanical compression devices, and IVC filters.All scientific publications discussing the use of biochemical, mechanical, and IVC filter prophylaxis for the prevention of DVT after trauma were identified using PubMed, EMBASE, and Medline. Search terms included: "DVT", "deep venous thrombosis", "complications", "trauma", "injury", "DVT prophylaxis", "low molecular weight heparin", "heparin", "chemical", "mechanical", "IVC filter" and/or "heparin-induced thrombocytopenia." The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was employed. Only English language publications were included. Once identified, manu