SESSION TYPE: DVT/PE
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: For members of the US Military who suffer traumatic injuries overseas, neuraxial blockade is often being employed for pain control. For patients hospitalized after trauma, 30 mg of lovenox BID is recommended for venous thromboembolism (VTE) prophylaxis, but BID low molecular weight heparin (LMWH) is contra-indicated for patients with neuraxial blockade in place. We sought to determine VTE rates for patients hospitalized after a traumatic injury who received neuraxial blockade.
METHODS: We abstracted data on all patients who were injured in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) and subsequently hospitalized at the Walter Reed Army Medical Center (WRAMC). Daily chemical prophylaxis was recorded, along with VTE rates.
RESULTS: A total of 199 patients were injured overseas and treated with neuraxial blockade while hospitalized at WRAMC between September, 2009 and March, 2011. Mean age and BMI for the group were 26.5±6.6 and 27.1±11.2, and 194 (97.5%) were male. Patients were hospitalized for 41.6±34.3 days, and 13 (16.5%) suffered a VTE during their admission. There was no significant difference in VTE rates for patients receiving UFH 5000U TID versus those prophylaxed with 40 mg enoxaparin QD (p=0.20). Patients who received enoxaparin 30 mg BID despite the presence of neuraxial blockade had the same VTE as those on enoxaparin 40 mg QD.
CONCLUSIONS: There is no significant difference in the VTE rate with different regimens of chemical prophylaxis for hospitalized veterans with traumatic injuries who use neuraxial blockade. Using 40 mg SQ enoxaparin QD is a reasonable approach to prophylaxis for these patients.
CLINICAL IMPLICATIONS: Dosing changes for chemical prophylaxis do not adversely affect VTE rates.
DISCLOSURE: The following authors have nothing to disclose: Paul Clark, Aaron Holley
No Product/Research Disclosure InformationWalter Reed National Military Medical Center, Bethesda, MD