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Thromboprophylaxis in Special Patients: Multiple Trauma, Head Trauma, and Spine Surgery

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Thromboembolism in Orthopedic Surgery

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Abstract

There is a significant clinical association between a traumatic event and the development of venous thromboembolism (VTE). In this chapter, we are reviewing VTE in patients with multiple trauma, head trauma, or acute spinal cord injury and in those undergoing spine surgery: to gain knowledge about the incidence of thromboembolic events in these specific conditions, to identify patients at high risk for this complication, to establish whether there is a safe period during which anticoagulant therapy can be delayed, to determine the risk of bleeding according to the type of drug given, and to provide a basis upon which appropriate thromboprophylactic protocols can be worked out and implemented.

In most trauma patients, thromboprophylaxis with LMWH can be started at 48 h, and in patients with active bleeding, mechanical compression should be considered, despite its limited effectiveness, until the risk of hemorrhage has decreased. In elective spinal surgery, the thromboembolic risk is relatively low, and the use of mechanical devices as primary prophylaxis seems reasonable. The currently available evidence does not suffice to support or negate the use of anticoagulant agents in this surgery, but it does exclude routine application, based on the low risk of fatal pulmonary embolism. These agents are, however, appropriate for patients with acute spinal cord injury, who require lengthy bed rest. There is not enough data to justify routine screening with ultrasound or venography in all these cases. Multimodal treatment (mechanical and pharmacological) that guarantees optimal thromboprophylaxis in this type of patient currently implies a rational, multidisciplinary decision, supported by evidence-based medicine.

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Authors and Affiliations

  1. Anaesthesia Department, Hospital Universitario Vall d’Hebron, Pssg. Vall d’Hebron 119–129, 08035, Barcelona, Spain

    Maria J. Colomina M.D., Ph.D., Lidia Mora M.D. & Esther Ciércoles M.D.

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  1. Maria J. Colomina M.D., Ph.D.
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  2. Lidia Mora M.D.
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  3. Esther Ciércoles M.D.
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Correspondence to Maria J. Colomina M.D., Ph.D. .

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Editors and Affiliations

  1. , Department of Anaesthesiology and Critic, University Hospital of Valencia, Valencia, 46010, Spain

    Juan V. Llau

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Colomina, M.J., Mora, L., Ciércoles, E. (2013). Thromboprophylaxis in Special Patients: Multiple Trauma, Head Trauma, and Spine Surgery. In: Llau, J. (eds) Thromboembolism in Orthopedic Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4336-9_11

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  • DOI: https://doi.org/10.1007/978-1-4471-4336-9_11

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  • Print ISBN: 978-1-4471-4335-2

  • Online ISBN: 978-1-4471-4336-9

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