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

Patients with lower extremity orthopedic trauma are at increased risk of venous thromboembolism (VTE). American College of Surgeons data revealed that a New York Level 2 Trauma Center administered unfractionated heparin (UFH) four times more often, and low molecular weight heparin (LMWH) two-and-a-half times less often, than national averages, despite institutional and national guidelines supporting use of LMWH over UFH. We retrospectively reviewed VTE prophylaxis practices in adult patients with lower extremity orthopedic trauma at the institution to identify trends and/or aberrant administration. Pearson chi-square tests of independence were utilized to determine significance. Approximately 57.3% received no preoperative VTE prophylaxis, whereas 32.8% received UFH and 9.1% received LMWH. Unfractionated heparin was administered at greater or equal frequency than LMWH within each age, sex, and diagnosis group. Patients admitted to general surgical units received UFH more frequently than those admitted to orthopedics. A multimodal intervention can be used to change current practices and improve care quality.