Highlights from AAST - risk factors for DVT and PE

One of our former students and researchers presented on risk factors for DVT and PE.

There is increased risk of DVT if prophylaxis is not instituted within 48h or thoracic injury AIS score is >3.

There is increased risk of PE if serum lactate is >5, or the patient is male.

COMPARING CLINICAL PREDICTORS OF DEEP VENOUS THROMBOSIS VERSUS PULMONARY EMBOLUS AFTER SEVERE BLUNT TRAUMATIC INJURY: A NEW PARADIGM FOR POST-TRAUMATIC VENOUS THROMBOEMBOLISM? Scott C. Brakenridge, MD MSCS, Steven Henley MS, T. Michael Kashner JD MPH PhD, Richard Golden PhD, Herbert A. Phelan* MD MSCS, Mitchell Jay Cohen* M.D., Jason L. Sperry* MD, Ernest E. Moore* M.D., Joseph P. Minei* M.D., Ronald V. Maier* M.D., Joseph Cuschieri* MD University of Washington Invited Discussant: Steven R. Shackford Introduction: The traditional paradigm is that DVT and PE after injury are different phases of a single disease process, often labeled as venous thromboembolism (VTE). However, we theorize that DVT and PE may represent independent thrombotic entities rather than different stages of a single pathophysiologic process. Methods: We examined a large, multi-center prospective observational cohort of severely injured blunt trauma patients to compare clinical risk factors for DVT and PE, including indicators of shock, injury severity, resuscitation parameters, comorbidities and VTE prophylaxis. Risk factors for each outcome were analyzed using best approximating, cross-validated logistic regressions selected using advanced stochastic/exhaustive search procedures. Results: The study cohort consisted of 1,822 severely injured blunt trauma patients (median ISS = 33, median base deficit = -9.5). Incidence of DVT and PE were 5.1% and 3.8% respectively. Only 9 of 159 (5.7%) patients with a VTE complication were diagnosed with both DVT and PE. Independent risk factors for DVT included ISS >24 (OR 1.91, 95% CI 1.09-3.36) and BMI >29 (OR 1.60, 95% CI 1.05-2.42), while independent risk factors for PE were serum lactate >5 (OR 2.61, 95% CI 1.61-4.23), male gender (OR 2.0, 95% CI 1.11-3.59) and crystalloid resuscitation > 15 L (OR 1.68, 95% CI 1.05-2.67). Conclusion: Risk factors for clinical diagnosis of DVT after severe blunt trauma appear to represent overall injury burden and obesity, while risk factors for PE are gender specific and more representative of shock state and overall physiologic derangement. Post-traumatic DVT and PE may represent distinct pathologic thrombotic processes as opposed to the traditional thrombus and subsequent embolus dogma of venous thromboembolism.