PURPOSE: Soldiers with traumatic injuries are at increased risk for venous thromboembolism (VTE). Complicated injury patterns and repeat trips to the operating room make prophylaxis difficult, and the optimal method for preventing VTE while minimizing bleeding risk is unknown.
METHODS: Data was abstracted for battle-injured soldiers evacuated from Afghanistan and Iraq from September 1st, 2009 through December 31st, 2010. We analyzed prophylaxis rates and efficacy, and identified risk factors for adverse outcomes. This project was part of an ongoing quality improvement initiative, and was considered exempt by Walter Reed DCI. Analysis was conducted using PASW 17 (Formerly Statistical Package for Social Sciences 17.0, SPSS Inc, Chicago, IL).
RESULTS: There were 746 patients during the specified time period (mean age 27.7±8.1 years, BMI 26.8±9.2; 97.3% male). 55% of patients had ≥1 surgery, 30.7% had neuraxial blockade for pain control, and 68.2% used sequential compression devices (SCDs) as part of their VTE prophylaxis regimen. 39 patients (5.2%) had a VTE within 3 months of their admission. Days at creatinine clearance (CrCl) < 30 ml/min (p<0.001), days with chemical VTE prophylaxis plus an anti-platelet agent (p<0.001), surgery (p<0.001), and BMI (p=0.004) were all significantly associated with bleeding. Only days with chemical prophylaxis plus an anti-platelet agent (OR 1.1; 95% CI: 1.0-1.1) and surgery during the admission (OR 3.3; 95% CI: 1.9-5.7) remained significantly associated with bleeding in multivariate analysis. Surgery (p=0.03), the need for blood products (p<0.001), neuraxial blockade (p=0.03), days without anti-coagulation (p=0.09), and average CrCl (p=0.09) were associated with having a VTE event. In multivariate analysis, only the need for blood products remained a significant predictor for VTE (OR 6.7; 95% CI: 2.5-17.9).
CONCLUSIONS: Our analysis helps better define risk factors for adverse outcomes among wounded soldiers and quantifies the magnitude of their effect.
CLINICAL IMPLICATIONS: Decisions about VTE prophylaxis and blood product replacement should be addressed on an ongoing basis in this population.
DISCLOSURE: The following authors have nothing to disclose: Sarah Petteys, Joshua Mitchell, Jacob Collen, Aaron Holley
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