A multicenter review of deep venous thrombosis prophylaxis practice patterns for blunt hepatic trauma

Thirty-seven (25%) and 45 (42%) patients received early and delayed DVT prophylaxis respectively. The remainder (32%) received none. Mean hepatic injury grades were lower in the early prophylaxis group (II) compared to the delayed and no prophylaxis cohorts (III)(p = 0.002). The number of patients requiring post-admission blood transfusions was highest in the delayed group (44%) compared to the early (26%) and no prophylaxis (6%) groups (p = 0.03). No patient in the early prophylaxis cohort developed a DVT or required delayed angiographic or operative intervention. Two patients in the delayed group failed non-operative management. Eight (18%) patients in the delayed group developed a clinically significant DVT; 1 (2%) progressed to a PE.Practice patterns indicate that chemical DVT prophylaxis initiated within 48 hours of admission may be safe in patients with significant blunt hepatic trauma. Delays in prevention result in venothromboembolic events, but not in fewer blood transfusions or a decreased need for subsequent angiographic or operative therapies.Hepatic trauma complicates 25% of all blunt injuries [1]. Modern management of these patients depends primarily upon their hemodynamic stability and concurrent pattern of injury. Recent series identify that 98% of all stable patients, regardless of injury grade, can be successfully managed without an operative procedure [2].Deep venous thrombosis (DVT) is a common complication. The observed incidence among trauma patients exceeds 50% when thromboprophylaxis is omitted [3]. Geerts and colleagues demonstrated that low molecular weight heparins (LMWH) significantly reduce the incidence of DVT compared to unfractionated heparin (UH), with rates of 7% and 15% respectively [4]. As a result, enoxaparin has become the standard pharmaceutical agent for DVT prophylaxis in multisystem trauma patients. In spite of its benefit, surgeons often delay the initiation of chemical DVT prophylaxis in those with blunt hepatic trauma due