Variability in Venous Thromboembolism Prophylaxis in Patients With Orthopedic Trauma at a Level 2 Trauma Center

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Pharmacology

Background:

• Patients with lower extremity orthopedic trauma face a high risk of venous thromboembolism (VTE).
• National guidelines recommend low molecular weight heparin (LMWH) over unfractionated heparin (UFH) for VTE prophylaxis.
• A specific trauma center's VTE prophylaxis practices deviated significantly from national averages and guidelines.

Purpose of the Study:

• To retrospectively review VTE prophylaxis practices in adult patients with lower extremity orthopedic trauma.
• To identify trends and aberrant administration of VTE prophylaxis at a New York Level 2 Trauma Center.
• To assess adherence to institutional and national guidelines favoring LMWH over UFH.

Main Methods:

• Retrospective review of VTE prophylaxis in adult patients with lower extremity orthopedic trauma.
• Analysis of administration rates of unfractionated heparin (UFH) and low molecular weight heparin (LMWH).
• Utilized Pearson chi-square tests of independence to determine statistical significance.

Main Results:

• Approximately 57.3% of patients received no preoperative VTE prophylaxis.
• Unfractionated heparin (UFH) was administered to 32.8%, while only 9.1% received low molecular weight heparin (LMWH).
• UFH was used more frequently than LMWH across all demographic and diagnostic groups, and in general surgical units compared to orthopedics.

Conclusions:

• Significant deviations from recommended VTE prophylaxis practices were observed, with underutilization of LMWH and overuse of UFH.
• A substantial proportion of patients did not receive any preoperative VTE prophylaxis.
• A multimodal intervention is proposed to improve VTE prophylaxis practices and enhance patient care quality.