A 30 year old man has been admitted to hospital with severe multiple injuries following a motor vehicle accident.
On day 2, his intracranial pressure has stabilised and his head CT shows scattered punctate haemorrhages with subarachnoid blood, with no mass lesion requiring evacuation. His pelvic fracture and right tibia / fibula fracture have been managed with external fixation and a left leg femoral fracture has undergone open reduction and internal fixation.
He has been in good health, but had a DVT 3 years ago and is not on any regular medication.
Outline your approach to prophylaxis for venous thrombo-embolism in this patient.
Answer and interpretation
Risk of VTE is high based on:
- Major trauma with pelvic and lower limb injury and operative intervention
- Possibility of a pro-thrombotic disorder
Therapy also has potential risks:
- Risk of intracranial haematoma expansion with unfractionated or LMW heparin
- Quantify potential pro-thrombotic disorder: ancillary history, previous
- Investigations, etc
- Unilateral mechanical prophylaxis
- Discuss timing of pharmacological prophylaxis
- Clinical and imaging surveillance
- IVC filter