Venous thromboembolism (VTE) prevention in the trauma patient: A national survey of practice.

Aim: Due to complex injury patterns, the safe timing of venous thromboembolism (VTE) prophylaxis in trauma patients is challenging. The purpose of this study was to characterize current thromboprophylaxis practice in trauma patients amongst trauma providers in Ireland.

Methods: We conducted a national, cross-sectional survey of trauma providers. The survey was sponsored by the Irish Network for VTE Research (INViTE) and disseminated through the national trauma and VTE office. The survey was a 35-item questionnaire and collected information regarding non-pharmacologic prophylaxis practice, preferred pharmacologic agent and dose, timing to initiation of prophylaxis in high-risk patients and selection of patients for extended thromboprophylaxis post discharge.

Results: A total of 116 trauma providers responded (estimated response rate among surgical specialities 11 %). Majority of respondents (72/116; 65 %) were consultant doctors or fellows. Thirty-seven percent of respondents (43/116) reported having a VTE guideline for trauma patients at their institution. Majority of respondents (115/116; 99 %) reported using some form of mechanical prophylaxis. The most common pharmacologic dosing regimen reported was enoxaparin 40 mg 24-hourly (44/116; 38 %). Forty-four percent of respondents (51/116) indicated adjusting doses in patients with obesity. A high degree of variability in initial timing of prophylaxis following traumatic brain injury, solid organ injury, and spinal column injuries was observed.

Conclusion: There is variable VTE prevention practice among trauma providers in Ireland. A standardized, national approach to VTE prevention in trauma care is needed.