High rate of immediate and early post-traumatic venous thromboembolism in combat soldiers

Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is a known complication of trauma. Combat-related injuries have unique characteristics which might increase the rate of early VTE. For that reason, we aimed to evaluate the incidence and characteristics of immediate and early VTE among combat casualties during the Swords of Iron war.

A multicenter retrospective study including combat injured personnel evacuated to a trauma center between October 26 and December 31, 2023. PE and DVT were diagnosed based on imaging reports by screening all medical records. VTE cases were classified as immediate (<6 h), early (6-72 h), or late (>72 h). Pre- and in-hospital characteristics were compared to matched controls.

Of 809 patients, 12 (1.5 %) had immediate or early PE and 4 (0.5 %) immediate or early DVT. Eleven PE cases involved chest and/or limb injuries, with 83 % diagnosed immediately by total body CT. Patients with immediate PE had higher rates of chest injuries, pre-hospital whole blood use, and tourniquet placement, though these differences were not statistically significant. DVT occurred in the injured limb in all cases. No VTE-related complications or interventions were reported.

Immediate and early VTE occurred at a higher rate than previously reported, highlighting the role of advanced diagnostic tools and rapid evacuation for early diagnosis. Further research is needed to assess the prognostic impact of immediate VTE diagnosis.