Use of low molecular weight heparin in preventing thromboembolism in trauma patients
Use of low molecular weight heparin in preventing thromboembolism in trauma patients
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DOI：
10.1097/00005373-199609000-00010
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发表时间：
1996-09-01
影响因子：
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通讯作者：
Shackleford, S
中科院分区：
文献类型：
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作者：
Knudson, MM;Morabito, D;Shackleford, S
目的：与机械预防方法相比，探讨低分子量肝素 (LMWH) 预防高危创伤患者深静脉血栓 (DVT) 的安全性和有效性。设计：在城市学术创伤中心进行的一项为期 19 个月的前瞻性随机试验。方法：所有具有以下发生 DVT 危险因素的创伤患者均被考虑纳入本研究：任何简明损伤量表评分大于或等于 3 分的损伤；严重头部损伤（格拉斯哥昏迷量表评分小于或等于8）；脊柱、骨盆或下肢骨折；急性静脉损伤；或年龄 > 50 档，经过静脉双重检查后，根据是否存在妨碍使用肝素的损伤，将患者分配至肝素组与无肝素组。在肝素组中，患者随后被随机分配接受 LMWH 或最佳机械加压（定义为双侧顺序梯度气动加压 (SCD)，或者在存在妨碍使用 SCD 的下肢损伤的情况下，接受动静脉脉冲 (AVI) 加压）无肝素组中的所有患者均接受了最佳加压，入组患者每 5 至 7 天接受一次连续双功能检查，直至出院。结果：在最初入组本研究的 487 名连续患者中，有 372 名患者至少接受了前两次双功能检查，构成研究人群。只有 9 名患者 (2.4%) 发生 DVT，而未接受预防的高危创伤患者的预测发生率为 9.1% (p = 0.037）。在 120 名随机接受 LMWH 的患者中，只有 1 名 (0.8%) 出现 DVT。在SCD组中，199名患者中有5名（2.5％）患有DVT，AVI组中53名患者中有3名（5.7％），1名DVT患者还具有肺栓塞的临床症状，但没有继发于肺栓塞的死亡，存在一种可能与使用LMWH相关的主要出血并发症。 结论：给予LMWH是一种安全且极其有效的预防高危创伤中DVT的方法对于患者，当肝素禁忌时，需要积极尝试机械压迫。
Objective: To investigate the safety and effectiveness of low molecular weight heparin (LMWH) in preventing deep venous thrombosis (DVT) in high-risk trauma patients, compared with mechanical methods of prophylaxis.Design: A prospective randomized trial conducted over a 19-month period in an urban, academic trauma center.Methods: All trauma patients with the following risk factors for the development of DVT were considered for enrollment in this study: any injury with an Abbreviated Injury Scale score greater than or equal to 3; major head injury (Glasgow Coma Scale score less than or equal to 8); spine, pelvic, or lower extremity fractures; acute venous injury; or age >50 gears, After a screening venous duplex examination, the patients were assigned to a Heparin versus No-Heparin group, depending upon the presence of injuries precluding the use of heparin, In the Heparin group, the patients were then randomized to receive either LMWH or optimal mechanical compression (defined as bilateral sequential gradient pneumatic compression (SCD) or, in the presence of lower extremity injuries precluding the use of the SCD, the arteriovenous impulse (AVI) compression system), All the patients in the No-Heparin group received optimal compression, Enrolled patients underwent sequential duplex examinations every 5 to 7 days until discharge.Results: Of the 487 consecutive patients initially enrolled in this study, 372 were available for at least the first two duplex examinations and comprise the study population, Only nine (2.4%) patients developed DVT, compared with the predicted 9.1% rate in high-risk trauma patients receiving no prophylaxis (p = 0.037). Of the 120 patients who were randomized to receive LMWH, only one (0.8%) developed DVT. In the SCD group, there were 5 of 199 patients (2.5%) with DVT, and 3 of 53 (5.7%) in the AVI group, One patient with DVT also had clinical symptoms of pulmonary embolism, but there were no deaths secondary to pulmonary embolism, There was one major bleeding complication potentially associated with the use of LMWH.Conclusions: The administration of LMWH is a safe and extremely effective method of preventing DVT in high-risk trauma patients, When heparin is contraindicated, aggressive attempts at mechanical compression are warranted.