Prevention of Deep Venous Thromboembolism

A 20-year retrospective analysis of deep venous thrombosis and pulmonary embolism among combat casualties requiring damage-control laparotomy at US military Role 2 surgical units

BACKGROUND

Combat casualties receiving damage-control laparotomy at forward deployed, resource-constrained US military Role 2 (R2) surgical units require multiple evacuations, but the added risk of venous thromboembolism (VTE) in this population has not been defined. To fill this gap, we retrospectively analyzed 20 years of Department of Defense Trauma Registry data to define the VTE rate in this population.

METHODS

Department of Defense Trauma Registry from 2002 to 2023 was queried for US military combat casualties requiring damage-control laparotomy at R2. All deaths were excluded in subsequent analysis. Rates of VTE were assessed, and subgroup analysis was performed on patients requiring massive transfusion.

RESULTS

Department of Defense Trauma Registry (n = 288) patients were young (mean age, 25 years) and predominantly male (98%) with severe (mean Injury Severity Score, 26), mostly penetrating injury (76%) and high mortality. Venous thromboembolism rate was high: 15.8% (DVT, 10.3%; pulmonary embolism, 7.1%). In the massively transfused population, the VTE rate was even higher (26.7% vs. 10.2%, p < 0.001).

CONCLUSION

This is the first report that combat casualties requiring damage-control laparotomy at R2 have such high VTE rates. Therefore, for military casualties, we propose screening ultrasound upon arrival to each subsequent capable echelon of care and low threshold for initiating thromboprophylaxis.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

Analysis of Related Influencing Factors of Deep Vein Thrombosis after Lumbar Internal Fixation and Treatment Strategy

Lumbar internal fixation is a traditional surgical method for the treatment of degenerative diseases of the lumbar spine. However, due to its large surgical trauma, it easily causes complications such as deep venous thrombosis (DVT) after the operation. DVT refers to the abnormal coagulation of blood in deep veins, blocking the lumen, causing venous blood return disorder, causing venous blood return disorder to cause swelling and pain, which affects the recovery of the patient's lumbar spine function. In severe cases, even complicated pulmonary embolism endangers the life and health of the patient. Therefore, it is extremely important to explore the related influencing factors and effective treatment of DVT. The purpose of this study was to investigate the influencing factors and effective treatment of DVT after lumbar internal fixation. Univariate analysis and multivariate a logistic regression model were used to analyze the related factors affecting DVT after lumbar internal fixation. Conventional treatments such as anticoagulation, promotion of venous blood return, and improvement of limb circulation were given to patients with DVT, and functional exercise was guided to compare the hypercoagulability and hyperviscosity of blood in patients with DVT before and after treatment. The results showed that the incidence of DVT after lumbar internal fixation was related to age, BMI, and bed time. Getting out of bed for functional exercise in time after surgery can effectively prevent the formation of DVT. Preoperative grading examination, intraoperative intervention, postoperative physical exercise, and other preventive guidance can be carried out according to different individuals during the perioperative period to prevent the formation of postoperative DVT.

Increase in Fibrinogen Degradation Product Levels 5 Days after a Traumatic Insult

Context:

Few reports have investigated the time course of fibrinogen (or fibrin) degradation product (FDP) levels for trauma patients in the subacute phase.

Aims:

This study aimed to investigate the time course of the FDP levels among patients with moderate and severe trauma in the subacute phase.

Settings and Design:

A retrospective medical chart review in a single hospital.

Subjects and Methods:

From September 2017 to March 2018, a medical chart review was retrospectively performed for all patients with trauma who were admitted to our department, and these patients were included as participants in the present study. We collected the data on each patient's sex, age, presence of head injury, mechanism of injury, Glasgow Coma Scale on arrival, systolic blood pressure, heart rate, type of injury (blunt versus penetrating), injury severity score, complication of infection, surgical procedure, duration of admission, survival rate, and FDP level from the 1^st to 7^th hospital day. The average level of FDP on each hospital day was compared with that on the previous day.

Statistical Analysis Used:

The statistical analyses were performed using a paired Student's t-test. P < 0.05 was considered to indicate a statistically significant difference.

Results:

From the 1^st to 4^th hospital day, the average level of FDP significantly diminished day by day. However, from the 5^th hospital day, the average level significantly increased. This trend persisted even after excluding the complications of infection and surgical procedures performed between the 2^nd and 7^th hospital day.

Conclusions:

Among trauma patients, the average level of FDP significantly diminished day by day from the admission to the 4^th hospital day; however, from the 5^th hospital day, the average level significantly increased. Further studies are needed to determine the time course of FDP or D-dimer levels in the long term and when FDP levels return to normal limits.