Modern aspects of epidemiology and therapy of venous thromboembolic complications in injuries.
Abstract
Patients who have suffered traumatic injuries are at high risk of developing venous thromboembolism. According to the literature, the incidence of deep vein thrombosis in patients with injuries varies from 20 to 90 %. The incidence of pulmonary embolism in this group of patients ranges from 2.3 to 22 %. An increase in the proportion of the elderly population and the survival rate of more severely injured patients may indicate an increased risk of thromboembolic complications in the population of traumatological patients. There are only a few randomized prospective studies evaluating methods for preventing thromboembolism in patients with injuries. There are disputes about the optimal method of prevention in this high-risk group. Contraindications related to concomitant injuries often limit possible prevention options in trauma patients. Large prospective randomized trials are needed to determine the most effective prevention methods in patients with injuries, which are characterized by a variety of both isolated and combined injuries. Future studies should also take into account the duration of prevention, as many patients with injuries remain immobilized for a long time. The review analyzes the opinions of various authors on the pathophysiology of thromboembolic complications, reflects the data of researchers on the frequency of this complication, the features of diagnosis and treatment of venous thromboembolic complications in patients with injuries. Information on the risk factors for thromboembolism and prevention options is provided separately.
About the Authors
I. Yu. Khodzhanov
Republican specialized Scientific and practical Medical Center of Traumatology and Orthopedics
Uzbekistan
Uzbekistan
Khodzhanov Iskandar Yunusovich – Doctor of Medical Sciences, Professor, Scientific Director of the Department of General Orthopedics
H. M. Jalilov
Samarkand State Medical University
Uzbekistan
Uzbekistan
Jalilov Husan Mukhidinovich – Assistant Professor of the Department of Traumatology and Orthopedics
D. Sh. Mansurov
Samarkand State Medical University
Uzbekistan
Uzbekistan
Mansurov Dzhalolidin Shamsidinovich – Candidate of Medical Sciences, Head of the Department of Radiation Diagnostics and Therapy
References
1. Божкова С. А., Тихилов Р. М., Андрияшкин В. В., и др. Профилактика, диагностика и лечение тромбоэмболических осложнений в травматологии и ортопедии: методические рекомендации. Травма. 2024;25(1):67–101. [Bozhkova S. A., Tikhilov R. M., Andriashkin V. V., et al. Prevention, diagnosis and treatment of thromboembolic complications in traumatology and orthopedics: methodological recommendations. Injury. 2024;25(1):67–101. (In Russ.)].
2. Диагностика, лечение и профилактика венозных тромбоэмболических осложнений: рекомендаци. Режим доступа: https://webmed.irkutsk.ru/doc/pdf/pe2015.pdf (дата обращения: 21.01.2025). [Diagnosis, treatment and prevention of venous thromboembolic complications: recommendations. Available from: https://webmed.irkutsk.ru/doc/pdf/pe2015.pdf (accessed: 21.01.2025) (In Russ.)].
3. Явелов И. С. Профилактика и лечение венозных тромбоэмболических осложнений: что надо знать практикующему врачу. Клинфарм. 2023;12(3):45–58. [Yavelov I. S. Prevention and treatment of venous thromboembolic complications: what a practicing doctor needs to know. Klinfarm. 2023;12(3):45–58. (In Russ.)].
4. Копенкин С. С. Предупреждение венозных тромбоэмболических осложнений при травмах опорно-двигательного аппарата. Медицинский совет. 2016;(10):143–147. [Kopenkin S. S. Prevention of venous thromboembolic complications in injuries of the musculoskeletal system. Medical advice. 2016;(10):143–147. (In Russ.)].
5. Румянцев А. Г., Масчан А. А. Профилактика венозной тромбоэмболии (ВТЭ) у детей и подростков. Lympha-Press. Режим доступа: https://lympha-press.ru/trombo (дата обращения: 21.01.2025). [Rumyantsev A. G., Maschan A. A. Prevention of venous thromboembolism (VTE) in children and adolescents. Lympha-Press. Available from: https://lympha-press.ru/trombo (accessed: 21.01.2025). (In Russ.)].
6. Пучков К. В. Профилактика тромбозов и ТЭЛА. Хирург. Режим доступа: https://www.puchkovk.ru/technology/profilaktika-tromboembolii-i-tela/ (дата обращения: 21.01.2025). [Puchkov K. V. Thromboembolism Prevention. The surgeon. Available from: https://www.puchkovk.ru/technology/profilaktika-tromboembolii-i-tela (accessed: 21.01.2025). (In Russ.)].
7. Божкова С. А. Профилактика, диагностика и лечение тромбоэмболических осложнений в травматологии и ортопедии: методические рекомендации. Журнал травматологии и ортопедии. 2022;28(4):1993. [Bozhkova S. A. Prevention, diagnosis and treatment of thromboembolic complications in traumatology and orthopaedics. Journal of Traumatology and Orthopedics. 2022;28(4):1993. (In Russ.)].
8. Doherty C. How to Dissolve Blood Clots in Legs. Verywell Health. 2024. Available from: https://www.verywellhealth.com/how-to-dissolve-blood-clots-in-legs-8651042 (accessed: 21.01.2025).
9. Geerts W. H., Bergqvist D., Pineo G. F., et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2012;133(6):381S–453S.
10. Gould M. K., Garcia D. A., Wren S. M., et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2):e227S–e277S.
11. Kakkar A. K., Cimminiello C., Goldhaber S. Z., et al. Low molecular-weight heparin and mortality in acutely ill medical patients. N. Engl. J. Med. 2011;365(26):2463–2472.
12. Cohen A. T., Davidson B. L., Gallus A. S., et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomized placebo controlled trial. BMJ. 2013;332(7537):325–329.
13. Barbar S., Noventa F., Rossetto V., et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J. Thromb. Haemost. 2010;8(11):2450–2457.
14. Spyropoulos A. C., Anderson F. A., FitzGerald G., et al. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest. 2011;140(3);706–714.
15. Decousus H., Tapson V. F., Bergmann J. F., et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest. 2011;139(1):69–79.
16. Tapson V. F., Decousus H., Pini M., et al. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest. 2012;132(3):936–945.
17. Samama M. M., Cohen A. T., Darmon J. Y., et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. N. Engl. J. Med. 2012;341(11):793–800.
18. Alikhan R., Cohen A. T., Combe S., et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch. Intern. Med. 2014;164(9):963–968.
19. Лега Д. Н., Столяров С. А., Супильников А. А. Современный подход к изучению проблемы патогенеза и профилактики венозных тромбоэмболических осложнений у пациентов с травмой (обзор литературы). Вестник медицинского института «РЕАВИЗ». Реабилитация, Врач и Здоровье. 2023;13(6):131–136. [Lega D. N., Stolyarov S. A., Supilnikov A. A. A modern approach to studying the problem of pathogenesis and prevention of venous thromboembolic complications in patients with trauma (literature review). Bulletin of the medical institute "REAVIZ". Rehabilitation, Doctor and Health. 2023;13(6):131–136. (In Russ.)].
20. Божкова С. А. Профилактика, диагностика и лечение тромбоэмболических осложнений в травматологии и ортопедии: методические рекомендации. Журнал травматологии и ортопедии. 2022;28(3):136–166. [Bozhkova S. A. Prevention, diagnosis and treatment of thromboembolic complications in traumatology and orthopedics: methodological recommendations. Journal of Traumatology and Orthopedics. 2022;28(3):136–166. (In Russ.)].
21. Власов С. В. Механизмы развития, прогноз и профилактика тромбообразования при травмах и ортопедических операциях с высоким риском тромбоэмболических осложнений: дисс. канд. мед. наук. Кемерово; 2014. 24 с. [Vlasov S. V. Mechanisms of development, prognosis and prevention of thrombosis in injuries and orthopedic operations with a high risk of thromboembolic complications: dissertation of the Candidate of medical Sciences. Kemerovo; 2014. 24 p. (In Russ.)].
22. Пестрикова Т. Ю., Юрасова Е. А., Юрасов И. В. и др. Профилактика тромбоэмболий: рациональный подход к ведению пациенток в послеоперационном периоде (обзор литературы). Акушерство и гинекология. 2023;12(3):45–58. [Pestrikova T. Yu., Yurasova E. A., Yurasov I. V., et al. Thromboembolism prevention: a rational approach to the management of patients in the postoperative period (literature review). Obstetrics and gynecology. 2023;12(3):45–58. (In Russ.)].
23. Глущенко В. А., Добрынина Ю. А., Донских Р. В. и др. Профилактика венозных тромбоэмболических осложнений у онкологических больных: учебное пособие. СПб: НМИЦ онкологии им. Н. Н. Петрова, 2024. 50 с. [Glushchenko V. A., Dobrynina Yu. A., Donskikh R. V., et al. Prevention of venous thromboembolic complications in cancer patients: a textbook. St. Petersburg: N. N. Petrov National Research Medical Center of Oncology; 2024. 50 p. (In Russ.)].
24. Профилактика венозной тромбоэмболии в травматологии. Кава-фильтры. MedUniver. Режим доступа: https://meduniver.com/Medical/travmi/profilaktika_venoznoi_tromboembolii.html (дата обращения: 21.01.2025). [Prevention of venous thromboembolism in traumatology. Kava filters. MedUniver. Available from: https://meduniver.com/Medical/travmi/profilaktika_venoznoi_tromboembolii.html (accessed: 21.01.2025). (In Russ.)].
25. Копенкин С. С. Предупреждение венозных тромбоэмболических осложнений при травмах опорно-двигательного аппарата. Медицинский совет. 2016;(10):143–147. [Kopenkin S. S. Prevention of venous thromboembolic complications in injuries of the musculoskeletal system. Medical advice. 2016;(10):143–147. (In Russ.)].
26. Попова Т. В., Кондратьева Т. Б., Каневская М. З. и др. Профилактика венозного тромбоэмболизма в отделениях реанимации (обзор). Вестник интенсивной терапии. 2020;7(2):45–58. [Popova T. V., Kondratieva T. B., Kanevskaya M. Z., et al. Prevention of venous thromboembolism in intensive care units (review). Bulletin of intensive care. 2020;7(2):45–58. (In Russ.)].
27. Милевски И. Венозная тромбоэмболия в травматологии. MedUniver. Режим доступа: https://meduniver.com/Medical/travmi/venoznaia_tromboembolia.html (дата обращения: 21.01.2025). [Milevsky I. Venous thromboembolism in traumatology. MedUniver. Available from: https://meduniver.com/Medical/travmi/venoznaia_tromboembolia.html (accessed: 21.01.2025). (In Russ.)].
28. Профилактика венозной тромбоэмболии в хирургической ортопедии. Резюме для клиницистов. Украинский медицинский журнал. 2012;93(2):45–50. [Prevention of venous thromboembolism in surgical orthopedics. Summary for clinicians. Ukrainian Medical Journal. 2012;93(2):45–50].
29. Профилактика венозной тромбоэмболии (ВТЭ) у детей и подростков. Lympha-Press. Режим доступа: https://lympha-press.ru/trombo (дата обращения: 21.01.2025). [Prevention of venous thromboembolism (VTE) in children and adolescents. Lympha-Press. Available from: https://lympha-press.ru/trombo (accessed: 21.01.2025). (In Russ.)].
30. Профилактика, диагностика и лечение тромбоэмболических осложнений в травматологии и ортопедии: методические рекомендации. Травма. 2024;25(1):67–101. [Prevention, diagnosis and treatment of thromboembolic complications in traumatology and orthopedics: methodological recommendations. Injury. 2024;25(1):67–101. (In Russ.)].
31. Geerts W. H., Bergqvist D., Pineo G. F., et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2012;133(6):381S–453S.
32. Gould M. K., Garcia D. A., Wren S. M., et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2):e227S–e277S.
33. Kakkar A. K., Cimminiello C., Goldhaber S. Z., et al. Low molecular-weight heparin and mortality in acutely ill medical patients. N. Engl. J. Med. 2011;365(26):2463–2472.
34. Cohen A. T., Davidson B. L., Gallus A. S., et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomized placebo controlled trial. BMJ. 2013;332(7537):325–329.
35. Barbar S., Noventa F., Rossetto V., et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J. Thromb. Haemost. 2010;8(11):2450–2457.
36. Spyropoulos A. C., Anderson F. A., FitzGerald G., et al. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest. 2011;140(3):706–714.
37. Geerts W. H., Bergqvist D., Pineo G. F., et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). Chest. 2012;141(2):e195S–e226S.
38. Cohen A. T., Agnelli G., Anderson F. A., et al. Venous thromboembolism (VTE) in Europe: the number of VTE events and associated morbidity and mortality. Thromb. Haemost. 2014; 98(4):756–764.
39. Spyropoulos A. C., Anderson F. A., FitzGerald G., et al. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest. 2011;140(3):706–714.
40. Gould M. K., Garcia D. A., Wren S. M., et al. Prevention of VTE in nonorthopedic surgical patients: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2):e227S–e277S.
41. Anderson F. A., Spencer F. A. Risk factors for venous thromboembolism. Circulation. 2015;107(23):I9–I16.
42. Rogers F. B., Shackford S. R., Horst M. A., et al. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. J. Trauma Acute Care Surg. 2016;81(4):1–10
43. Toker S., Hak D . J., Morgan S. J. Venous thromboembolic prophylaxis in trauma patients: a review Curr. Opin. Orthop. 2017;18(4):366–370.
44. Bauer K. A., Lip G. Y. Clinical practice: venous thromboembolism. N. Engl. J. Med. 2012;347(18):370–371.
45. Kakkar A. K., Davidson B. L., Haas S . K., et al. Compliance with recommended prophylaxis for venous thromboembolism: improving practice. Am. J. Med. 2016;119(2):130–135.
46. Samama M. M., Cohen A. T., Darmon J. Y., et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. N. Engl. J. Med. 2014;341(11):793–800.
47. Tetsworth K., Patil S., Gianoutsos M. Extended prophylaxis in trauma patients: is it necessary and does it work? Injury. 2018;49(2):201–207.
48. Baldwin A. L., Scott M. E., Huyett J. P., et al. The use of inferior vena cava filters in trauma patients: a 10-year analysis. J. Trauma Acute Care Surg. 2017;72(4):773–777.
49. Decousus H., Tapson V. F., Bergmann J. F., et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest. 2013; 139(1):69–79.
50. Falck-Ytter Y., Francis C. W., Johanson N. A., et al. Prevention of VTE in orthopedic surgical patients: American College of Chest Physicians Evidence-Based Clinical Practice Guide lines. Chest. 2012;141(2):e278S–e325S.
51. Tapson V. F., Decousus H., Pini M., et al. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest. 2012;132(3): 936–945.
52. Alikhan R., Cohen A/ T., Combe S., et al. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch. Intern. Med. 2014;164(9):963–968.
53. Mahan C. E., Spyropoulos A. C., Yanek L. R., et al. New oral anticoagulants for the prevention of venous thromboembolism. Curr. Opin. Hematol. 2018;15(4):376–382.
54. Barbar S., Noventa F., Rossetto V., et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J. Thromb. Haemost. 2012;8(11):2450–2457.
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For citations:
Khodzhanov I.Yu., Jalilov H.M., Mansurov D.Sh. Modern aspects of epidemiology and therapy of venous thromboembolic complications in injuries. Russian surgical journal. 2025;1(1):72-78. (In Russ.)
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