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ICU Management: Venous Thromboembolism

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Textbook of Polytrauma Management

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Abstract

Polytrauma patients treated in the intensive care unit (ICU) are at high risk of venous thromboembolism (VTE). The primary goal of treatment is the prevention of symptomatic deep vein thrombosis/pulmonary embolism (PE) and fatal PE. VTE screening using imaging examination is insufficient for this purpose. Chemical prophylaxis is the main modality of VTE prophylaxis for polytrauma patients treated in the ICU. While the applicability of mechanical prophylaxis in polytrauma patients is limited, mechanical prophylaxis can be applied alongside chemical prophylaxis. Low-molecular-weight or low-dose unfractionated heparin is recommended for use in polytrauma patients. A history of heparin-induced thrombocytopenia is a contraindication for heparin use in chemical thromboprophylaxis; instead, Xa inhibitors may be considered. Chemical thromboprophylaxis using anticoagulants is recommended once the initial bleeding caused by the trauma has been stopped. Approximately 2 days after the initial trauma, the thrombosis risk is considered to be greater than the bleeding risk. Therefore, the appropriate period to commence chemical thromboprophylaxis falls between 3 and 8 ICU days. The contraindications for chemical thromboprophylaxis include active bleeding or risk of bleeding, intracranial hemorrhage, spinal injury, abdominal organ injury, and coagulopathy. The indications for inferior vena cava filter use in polytrauma patients remain controversial.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Takahiro Niikura

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  1. Takahiro Niikura
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Correspondence to Takahiro Niikura .

Editor information

Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

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Niikura, T. (2022). ICU Management: Venous Thromboembolism. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_38

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  • DOI: https://doi.org/10.1007/978-3-030-95906-7_38

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95905-0

  • Online ISBN: 978-3-030-95906-7

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