Table 1

Hospitals’ guidelines for DVT prophylaxis within trauma patients

Hospital 1Mechanical compression devices and TEDS applied, unless patient suffered leg fracture or has poor arterial perfusion of legs
Trauma patients with multiple DVT risk factors, especially prior DVT, should receive subcutaneous heparin 5000 units every 12 hours.* Spinal cord injury patients should receive subcutaneous heparin, adjusted to maintain a PTT=35–40. Treatment may be discontinued when spasticity develops. Risk factors for DVT include:
  • ▸ Age >40+bed rest >3 days

  • ▸ Prior DVT

  • ▸ Coma (GCS<7)

  • ▸ Spine fracture

  • ▸ Quadriplegia/paraplegia

  • ▸ Pelvic fracture

  • ▸ Leg/hip fracture

  • ▸ Cancer

  • ▸ CHF

  • ▸ General surgery+bed rest

  • ▸ Lupus anticoagulant

  • ▸ Hereditable coagulation deficiencies

  • ▸ Nephrotic syndrome

  • ▸ Stroke

  • ▸ Urological surgery

  • ▸ Myocardial infarction

  • ▸ Older age

  • ▸ Obesity

  • ▸ Oral contraception

  • ▸ Pregnancy/postpartum

  • ▸ Ulcerative colitis/inflammatory bowel disease

  • ▸ Sepsis

  • ▸ Myeloproliferative disease

  • ▸ Varicose veins

  • ▸ Smoking

Hospital 2Patients >16 years—mechanical compression devices and TEDS applied to uninjured leg or both legs if possible
All patients not at risk for bleeding with anticipated stay >48 hours and non-ambulatory should receive chemical prophylaxis. Patients initially at risk for further bleeding can have chemical prophylaxis started within 72 hours of injury.
Trauma patients without contraindications should receive enoxaparin (30 mg, subcutaneous, twice per day) unless a dose adjustment is needed due to geriatric age, weight, or renal failure. Patients with epidural catheters and ICP monitors will receive 40 mg of subcutaneous enoxaparin once a day. Enoxaparin is held 24 hours prior to placement of epidural or ICP.
Preoperative chemical prophylaxis will not be held for surgical procedures unless requested by surgeon.
Hospital 3No formal prophylaxis protocol. Treated per physician opinion
  • *Per communication with the trauma services department, the current practice has changed without an update to the protocol; it is standard procedure to use enoxaparin for chemical prophylaxis.

  • CHF, congestive heart failure; GCS, Glasgow Coma Scale; ICP, intracranial pressure; PTT, partial thromboplastin time; TEDS, thromboembolism deterrent stockings.