A National Survey of Thromboprophylaxis Strategies in High Risk Trauma Patients'
CCCF ePoster library. Curtis R. Nov 2, 2016; 150989; 108
Dr. R. Mason Curtis
Dr. R. Mason Curtis
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Abstract
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#108

Topic: Survey or Interview (quantitative or qualitative)

A National Survey of Thromboprophylaxis Strategies in High Risk Trauma Patients'


Curtis, R. Mason1; Vogt, Kelly2; Leeper, W. Robert2,3; Parry, Neil2,3; Ball, Ian3

1
Division of Emergency Medicine, Western Univeristy, London, Canada; 2Department of Surgery, Western University, London, Canada; 3Division of Critical Care, Western University, London, Canada

Abstract:

Introduction
 
The risk of venous thromboembolism (VTE) is very high in trauma patients, and VTE prophylaxis by means of chemical anticoagulation has become the standard of care in this patient population. However, a number of patients are unable to receive chemical anticoagulation due to the nature of their traumatic injury, some of whom are deemed to be at very high risk of VTE development. These patients have been defined by the Eastern Association for the Surgery of Trauma. Current non-pharmacologic based strategies of VTE prophylaxis include mechanical pneumatic compression devices, stocking devices, or retrievable inferior vena cava filters (rIVCF). There is currently no literature describing contemporary use of these devices among Canadian Trauma Care providers.
 
Objectives
 
To examine VTE prophylaxis strategies for trauma patients throughout Canada.
To determine current perception regarding the use of rIVCF for primary VTE prophylaxis in high risk trauma patients.
 
Methods
 
An online survey based questionnaire was distributed electronically to 16 Trauma Directors of Canadian Tertiary Care Trauma Centers. This survey was hosted on the REDCap platform, and was analysed with REDCap software using descriptive statistics.  The 19 question survey was designed and refined by all study authors, targeting demographic and clinical practice patterns of VTE prophylaxis strategies in trauma patients.
 
Results
 
We obtained a survey response rate of 88%. Fifty percent of our surveyed centres see > 650 severe trauma (ISS>12) patients annually. All responders prefer low molecular weight heparin for VTE prophylaxis over other modalities. When chemical anticoagulation is contraindicated, intermittent pneumatic compression device was the first line therapy in 79%; rIVCF was first line in 21% of centres. Sixty-five percent of responders agree that the risk of rIVCF is outweighs the benefit, however, 86% supported the need for future research in Canadian trauma population, and 64% agree sufficient clinical equipoise exists to support randomization for a prospective clinical trial.
 
Conclusions
 
This survey based investigation of Trauma Directors across Canada has identified clinical variation in use of rIVCF for primary prophylaxis in high risk trauma patients, and underscores the need for further prospective investigation regarding their use in this patient population.
 


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