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Thromboprophylaxis after multiple trauma: what treatment and for how long?

机译：多发性创伤后的血栓预防：什么治疗和持续多长时间？

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A review of current literature discussing thromboprophylaxis in the multiple-trauma patient to provide insight on the type of treatment and its duration of use. AMEDLINE search was conducted in May 2009 using keywords associated with thromboprophylactic measures in multiple-trauma patient care, including inferior vena cava (IVC) filters, mechanical-compression devices and anticoagulants. Abstracts were evaluated for relevance to this study and full-text articles were then examined individually. Fourteen full text articles were evaluated including guidelines published by the American College of Chest Physicians (ACCP) and the Eastern Association for the Surgery of Trauma (EAST) and other studies dealing with multiple-trauma patients, including those in hip-fracture surgery, lower-leg trauma and head trauma. Limited research has been performed for the multipletrauma patient and recommendations regarding the type of treatment and its duration of use cannot be suggested beyond what has been extrapolated from existing trauma and major surgery patients. IVC filters, mechanical compression devices and anticoagulants therefore remain the standard, but their duration of use in the multiple-trauma patient is not well described. New oral anticoagulants that inhibit factor Xa or thrombin directly show promising qualities but have not been evaluated for multiple-trauma applications. Therefore, optimal thromboprophylaxis and its duration after multiple trauma is largely based on rational, clinical decision making on a case-by-case basis.
机译：一篇有关多创伤患者预防血栓形成的最新文献的综述，以提供有关治疗类型及其使用持续时间的见解。 AMEDLINE搜索是在2009年5月使用与多发性创伤患者护理中的血栓预防措施相关的关键字进行的，包括下腔静脉（IVC）过滤器，机械加压装置和抗凝剂。评估摘要与本研究的相关性，然后逐篇检查全文。评估了14篇全文文章，包括由美国胸科医师学院（ACCP）和东方创伤外科协会（EAST）出版的指南，以及涉及多发性创伤患者的其他研究，包括髋部骨折手术患者，腿外伤和头部外伤。对于多发伤患者进行了有限的研究，仅从现有创伤和大手术患者的推断中不能提出有关治疗类型及其使用持续时间的建议。因此，IVC过滤器，机械加压装置和抗凝剂仍然是标准配置，但是对于多发性创伤患者的使用期限没有得到很好的描述。抑制因子Xa或凝血酶的新型口服抗凝剂直接显示出令人鼓舞的品质，但尚未针对多创伤应用进行评估。因此，最佳的血栓预防措施及其在多发性创伤后的持续时间在很大程度上是基于个案的合理临床决策。

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