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Higher risk of DVT and PE
1%
8/1211
Higher risk of DVT, same risk of PE
0%
6/1211
Same risk of both DVT and PE
9%
103/1211
Lower risk of DVT but higher risk of PE
2%
30/1211
Lower risk of DVT and PE
87%
1053/1211
Select Answer to see Preferred Response
Combined pharmacologic and mechanical prophylaxis has been shown to lower the rate of deep vein thrombosis (DVT) and pulmonary embolism (PE) in trauma patients. Patients who are immobilized after sustaining traumatic injuries are at elevated risk of DVT and PE. Virchow's triad describes factors associated with DVT formation: venous stasis, hypercoagulability, and intimal injury. Mechanical pneumatic prophylaxis prevents DVT formation by increasing venous return, decreasing venous stasis, and increasing endothelial-derived fibrinolysis. Currently, the standard of care for DVT and PE prophylaxis in patients with multiple traumatic injuries preventing ambulation is mechanical prophylaxis and enoxaparin. However, research is being done to compare the efficacy of enoxaparin to other chemoprophylactic agents (e.g. aspirin) in these patients. Stannard et al. performed a prospective randomized controlled trial (RCT) investigating venous thromboembolic disease following trauma in which they compared patients who had received enoxaparin within 48 hours of blunt trauma (Group A) to a separate group that received pulsatile foot pumps at the time of admission and enoxaparin five days after admission (Group B). They found that Group B had a lower rate of large or occlusive DVT (2.9% vs 11.3%), and a lower rate of PE (0% vs 2.1%). They concluded that early mechanical prophylaxis with delayed enoxaparin is a successful prophylactic strategy for venous thromboembolic disease following serious musculoskeletal injury. Kakkos et al. performed a Cochrane systematic review of RCTs of combined intermittent pneumatic leg compression (IPC) and pharmacologic DVT prophylaxis. They included 37 studies with over 16,000 participants and found that combined IPC and pharmacologic DVT prophylaxis decreased the rate of DVT and PE but that pharmacologic treatment also increased the risk of bleeding. The authors concluded that moderate-quality evidence supports the use of combined modalities in hospitalized patients at risk of developing VTE. Incorrect Answers: Answer 1-3: these can each be ruled out because the risk of DVT is lower with combined chemical and mechanical DVT prophylaxis. Answer 4: The risk of PE is lower, not higher with combined chemical and mechanical DVT prophylaxis.
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