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A national survey of thromboprophylaxis strategies in high risk trauma patients

R Mason Curtis*, Kelly Vogt, W Robert Leeper, Amol Mujoomdar, Stewart Kribs4, Neil Parry, Ian Ball

Purpose: The risk of venous thromboembolism (VTE) is very high in trauma patients, and VTE prophylaxis by means of pharmacological anticoagulation has become the standard of care in this patient population. Some patients are unable to receive pharmacological VTE prophylaxis and may be high risk for development of VTE. Contemporary use of mechanical prophylaxis with retrievable inferior vena cava filters (rIVCF) among Canadian trauma centers is unknown. The goal of our survey was to better understand current Canadian practices regarding rIVCF for VTE prophylaxis in this challenging patient population. Methods: An online survey based questionnaire was distributed to 16 Canadian Tertiary Care Trauma Center directors. This survey was hosted on the REDCap platform, and was analysed with REDCap software. Results: Response rate was 88%. Fifty percent of our surveyed centres see > 650 severe (ISS >12) trauma patients annually. All responders prefer low molecular weight heparin for VTE prophylaxis over other modalities. When pharmacological anticoagulation contraindicated, a pneumatic compression device was first line in 79%; rIVCF was first line in 21% of centres. Sixty-five percent of responders agree that the risk of rIVCF outweighs its benefit, however, 86% supported the need for future research in the Canadian trauma population, and 64% agree that sufficient clinical equipoise exists to support randomization for a prospective clinical trial. Conclusions: This survey based investigation of Canadian trauma directors has identified notable practice variation regarding rIVCF use for primary prophylaxis and underscores the need for further investigation of their use in high-risk trauma patients