Venous thromboembolism burden in IVC injuries: Is there an optimal strategy in prevention?

Venous thromboembolism (VTE) is a common complication in trauma patients; however, there have been limited studies on VTEs and the prevention thereof in patients with inferior vena cava (IVC) injuries. This study aimed to examine VTE incidence and the preventative efficacy of VTE prophylaxis regimens after operative IVC repair.

A 12-year retrospective review was performed of all patients who presented with IVC injuries to an urban level 1 trauma center. A subgroup analysis of VTE incidence, prophylaxis regimen (i.e., prophylactic anticoagulation [PAC] and/or antiplatelet [AP]) efficacy, and other clinical variables was performed on patients who underwent a primary or patch IVC repair and survived > 72 h.

A total of 132 patients presented with IVC injuries requiring operative management, with 56% overall survival. Among the 66 patients who received primary or patch repair and survived > 72 h, 27% had a VTE during index hospitalization and/or readmission. VTEs occurred a median of 9 days post-injury, and the most common type of VTE was deep vein thrombosis, followed by IVC thrombosis and pulmonary embolism. There were no significant differences in any clinical variables compared between patients who developed VTEs during index hospitalization and those who did not, including VTE prophylaxis timing, hospital or ICU length-of-stay, and injury severity score. Index hospitalization VTE rates differed significantly based on prophylaxis strategy (p = 0.018), with a 100% (2/2) VTE rate among patients who received no prophylaxis, a 22% (11/50) rate among patients who received a single modality (AP or PAC), and a 7% (1/14) rate among patients who received dual strategies (AP+PAC). However, VTE rates did not differ between single- and dual-prophylaxis strategies when compared directly.

Patients undergoing primary or patch IVC repair experienced high rates of VTEs, but these rates differed by prophylaxis strategies. While we observed trends toward reduction in the incidence of VTE with dual (PAC + AP) modalities versus single modality therapy, this study was underpowered to observe an actual effect given the small sample size. Further research or prospective trials are warranted to determine optimal prophylaxis strategies, especially given the markedly elevated VTE risk in patients with IVC injuries.