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International Orthopaedics

, Volume 39, Issue 5, pp 947–954 | Cite as

Post-traumatic thrombo-embolic complications in polytrauma patients

  • Philipp LichteEmail author
  • Philipp Kobbe
  • Khalid Almahmoud
  • Roman Pfeifer
  • Hagen Andruszkow
  • Frank Hildebrand
  • Rolf Lefering
  • Hans-Christoph Pape
  • Trauma Register DGU
Original Paper

Abstract

Introduction

Thrombo-embolic events after trauma are considered to be life-threatening complications. Our aim was to determine the incidence of arterial and venous thrombo-embolic events (TE) in severely-injured trauma patients, and its associated risk factors by using a large trauma registry.

Methods

Patients' data from the TraumaRegister DGU® (TR-DGU) were screened for TE (DVT [symptomatic deep vein thrombosis], PE [symptomatic pulmonary embolism], MI [myocardial infarction], and stroke) through the clinical course of severely injured adult trauma patients from January 2005 to December 2012. Univariate analysis was used to compare the clinical outcomes (endpoints: mortality, ICU and hospital length of stay, ventilator days), and a multivariate regression analysis was used to assess the independent risk factors associated with each TE event.

Results

From a cohort of 40,846 trauma patients, 1122 (2.8 %) patients developed a TE during their post-traumatic clinical course (313, 0.8 % DVT; 425, 1.0 % PE; 160, 0.4 % MI and 231, 0.6 % stroke). ICU length of stay [LOS], total LOS, days on mechanical ventilation, and incidence of multiple organ failure (MOF) and sepsis were significantly increased in patients with TE complications. Injury severity, major pelvic injury, and one or more operations were found to be independent risk factors for the development of DVT. Age ≥ 60 years, male gender, and more than one operation were risk factors for PE development. For MI age was the only significant risk factor. The occurrence of a stroke is increased in patients with an age ≥ 60 years, major head injury (AIS head ≥ 3), and more than one operation. Finally, mortality rates were significantly higher in the TE group when compared to the non-TE cohort (21.8 % vs. 12.7 %; p < 0.001).

Conclusion

TE complications were associated with longer ICU and hospital stay as well as a higher mortality. Overall, age and repeated operations were the most important risk factors for the development of TE events.

Keywords

Polytrauma Embolic complication Risk factor 

Notes

Conflict of interest

All authors declare no conflict of interests.

References

  1. 1.
    Guryel E, Pearce R, Rickman M, Bircher M (2012) Thrombo-prophylaxis in pelvic and acetabular trauma patients: a UK consensus? Int Orthop 36(1):165–169CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG (2004) Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(3 Suppl):338S–400SCrossRefPubMedGoogle Scholar
  3. 3.
    Paffrath T, Wafaisade A, Lefering R, Simanski C, Bouillon B, Spanholtz T, Wutzler S, Maegele M, Trauma Registry of DGU (2010) Venous thromboembolism after severe trauma: incidence, risk factors and outcome. Injury 41(1):97–101CrossRefPubMedGoogle Scholar
  4. 4.
    Di Minno MN, Tufano A, Ageno W, Prandoni P, Di Minno G (2012) Identifying high-risk individuals for cardiovascular disease: similarities between venous and arterial thrombosis in perspective. A 2011 update. Intern Emerg Med 7(1):9–13CrossRefPubMedGoogle Scholar
  5. 5.
    Burke JF, Stulc JL, Skolarus LE, Sears ED, Zahuranec DB, Morgenstern LB (2013) Traumatic brain injury may be an independent risk factor for stroke. Neurology 81(1):33–39CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Kamel H, Johnston SC, Kirkham JC, Turner CG, Kizer JR, Devereux RB, Iadecola C (2012) Association between major perioperative hemorrhage and stroke or Q-wave myocardial infarction. Circulation 126(2):207–212CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Aldemir M, Tacyildiz I, Girgin S (2004) Predicting factors for mortality in the penetrating abdominal trauma. Acta Chir Belg 104(4):429–434PubMedGoogle Scholar
  8. 8.
    Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, Huang W, Zayaruzny M, Emery L, Anderson FA Jr et al (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371(9610):387–394CrossRefPubMedGoogle Scholar
  9. 9.
    Yassin M, Mitchell C, Diab M, Senior C (2014) The necessity of pharmacological prophylaxis against venous thromboembolism in major joint arthroplasty. Int Orthop 38(5):1073–1075CrossRefPubMedGoogle Scholar
  10. 10.
    Franchini M, Mannucci PM (2012) Association between venous and arterial thrombosis: clinical implications. Eur J Intern Med 23(4):333–337CrossRefPubMedGoogle Scholar
  11. 11.
    Brenneman FD, Redelmeier DA, Boulanger BR, McLellan BA, Culhane JP (1997) Long-term outcomes in blunt trauma: who goes back to work? J Trauma 42(5):778–781CrossRefPubMedGoogle Scholar
  12. 12.
    Adams SD, Cotton BA, McGuire MF, Dipasupil E, Podbielski JM, Zaharia A, Ware DN, Gill BS, Albarado R, Kozar RA et al (2012) Unique pattern of complications in elderly trauma patients at a level I trauma center. J Trauma Acute Care Surg 72(1):112–118PubMedGoogle Scholar
  13. 13.
    Stawicki SP, Grossman MD, Cipolla J, Hoff WS, Hoey BA, Wainwright G, Reed JF 3rd (2005) Deep venous thrombosis and pulmonary embolism in trauma patients: an overstatement of the problem? Am Surg 71(5):387–391PubMedGoogle Scholar
  14. 14.
    Montgomery KD, Geerts WH, Potter HG, Helfet DL (1996) Thromboembolic complications in patients with pelvic trauma. Clin Orthop Relat Res 329:68–87CrossRefPubMedGoogle Scholar
  15. 15.
    Tawil I, Stein DM, Mirvis SE, Scalea TM (2008) Posttraumatic cerebral infarction: incidence, outcome, and risk factors. J Trauma 64(4):849–853CrossRefPubMedGoogle Scholar
  16. 16.
    Assmann G, Cullen P, Schulte H (2002) Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 105(3):310–315CrossRefPubMedGoogle Scholar
  17. 17.
    Britt LD, Zolfaghari D, Kennedy E, Pagel KJ, Minghini A (1996) Incidence and prophylaxis of deep vein thrombosis in a high risk trauma population. Am J Surg 172(1):13–14CrossRefPubMedGoogle Scholar
  18. 18.
    Anderson FA Jr, Spencer FA (2003) Risk factors for venous thromboembolism. Circulation 107(23 Suppl 1):I9–16PubMedGoogle Scholar
  19. 19.
    Gearhart MM, Luchette FA, Proctor MC, Lutomski DM, Witsken C, James L, Davis K Jr, Johannigman JA, Hurst JM, Frame SB (2000) The risk assessment profile score identifies trauma patients at risk for deep vein thrombosis. Surgery 128(4):631–640CrossRefPubMedGoogle Scholar
  20. 20.
    Cushman M (2007) Epidemiology and risk factors for venous thrombosis. Semin Hematol 44(2):62–69CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Knudson MM, Ikossi DG (2004) Venous thromboembolism after trauma. Curr Opin Crit Care 10(6):539–548CrossRefPubMedGoogle Scholar
  22. 22.
    Toker S, Hak DJ, Morgan SJ (2011) Deep vein thrombosis prophylaxis in trauma patients. Thrombosis 2011:505373CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Greenfield LJ, Proctor MC, Rodriguez JL, Luchette FA, Cipolle MD, Cho J (1997) Posttrauma thromboembolism prophylaxis. J Trauma 42(1):100–103CrossRefPubMedGoogle Scholar
  24. 24.
    Lau P, Ong V, Tan WT, Koh PL, Hartman M (2012) Use of activated recombinant factor VII in severe bleeding - evidence for efficacy and safety in trauma, postpartum hemorrhage, cardiac surgery, and gastrointestinal bleeding. Transf Med Hemother 39(2):139–150CrossRefGoogle Scholar
  25. 25.
    Chen H, Xue LX, Guo Y, Chen SW, Wang G, Cao HL, Chen J, Tian HL (2013) The influence of hemocoagulation disorders on the development of posttraumatic cerebral infarction and outcome in patients with moderate or severe head trauma. BioMed Res Int 2013:685174PubMedCentralPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2015

Authors and Affiliations

  • Philipp Lichte
    • 1
    Email author
  • Philipp Kobbe
    • 1
  • Khalid Almahmoud
    • 1
    • 2
  • Roman Pfeifer
    • 1
    • 5
  • Hagen Andruszkow
    • 1
    • 5
  • Frank Hildebrand
    • 1
  • Rolf Lefering
    • 3
  • Hans-Christoph Pape
    • 1
  • Trauma Register DGU
    • 4
  1. 1.Department of Orthopaedic Trauma SurgeryUniversity Hospital AachenAachenGermany
  2. 2.Department of SurgeryUniversity of PittsburghPittsburghUSA
  3. 3.Institute for Research in Operative Medicine (IFOM)University of Witten/HerdeckeCologneGermany
  4. 4.Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Section NIS)CologneGermany
  5. 5.Harald Tscherne Research Laboratory for Orthopaedic Trauma, Department of Orthopaedic Trauma SurgeryUniversity Hospital RWTH AachenAachenGermany

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