A Systems-based Approach to Reduce Deep Venous Thrombosis and Pulmonary Embolism in Trauma Patients
| Autor: | Ting Lung Lin, Russell Mason, Navpreet K. Dhillon, Galinos Barmparas, Daniel R. Margulies, Bruce L. Gewertz, Audrey R. Yang, Eric J. Ley, Harveen K Sekhon, Nikhil T Linaval |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Trauma center Vascular surgery medicine.disease Pulmonary embolism Cardiac surgery 03 medical and health sciences Venous thrombosis 0302 clinical medicine Blunt trauma 030220 oncology & carcinogenesis Anesthesia medicine 030211 gastroenterology & hepatology Surgery Dosing business Abdominal surgery |
| Zdroj: | World Journal of Surgery. 45:738-745 |
| ISSN: | 1432-2323 0364-2313 |
| DOI: | 10.1007/s00268-020-05849-9 |
| Popis: | Venous thromboembolism (VTE) in trauma patients carries significant morbidity and mortality. We previously described how titrating enoxaparin dosing by anti-Xa trough levels was associated with a lower VTE rate. We combined this strategy with a higher initial enoxaparin dose for a majority of patients and modified the electronic medical record (EMR) to encourage immediate dosing. We sought to determine if this systems-based approach was associated with a decrease in VTE rate. A retrospective review was conducted of all trauma patients on prophylactic enoxaparin at an academic, Level I Trauma Center from 01/2013 to 05/2014 (PRE) and 06/2015 to 02/2018 (POST). The patients in PRE were prescribed enoxaparin 30 mg twice daily without dose adjustments. The patients in POST received 40 mg twice daily unless exclusion criteria applied, with doses titrated to maintain anti-Xa trough levels between 0.1 and 0.2 IU/mL. There were 478 patients in the PRE and 1306 in the POST. Compared to PRE, POST patients were of similar age and were as likely to present after blunt trauma, although POST patients had lower injury severity scores (10 vs. 9, p |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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