Thromboembolic Events among Multiple Trauma Victims with Pelvic Fractures with Injury Severity Score Greater Than 16 with and without Deep Vein Thrombosis Prophylactic Doses of Enoxaparin


Multiple Trauma
Venous Thrombosis

How to Cite

Ostovari A, Shahabinezhad A, Sarejloo S, Mesbahi SA, Saem J, Hamidianshirazi Y, Bananzadeh A, Paydar S, Salimi M. Thromboembolic Events among Multiple Trauma Victims with Pelvic Fractures with Injury Severity Score Greater Than 16 with and without Deep Vein Thrombosis Prophylactic Doses of Enoxaparin. Surg Insights [Internet]. 2022 Sep. 8 [cited 2024 Jul. 19];. Available from:


Introduction: Venous thromboembolism (VTE) is a common life-threatening complication in patients affected by severe trauma. The clinical manifestations of VTE are deep venous thrombosis (DVT) and pulmonary embolism (PE). Various prophylactic pharmacological strategies are used. We studied the efficacy of enoxaparin in preventing VTE in our level 1 trauma center. Materials and Methods: This cross-sectional study included patients with polytrauma with an Injury Severity Score (ISS) of greater than 16 units and a pelvis fracture diagnosis. Clinical features, laboratory data, and images were reviewed from medical documents. Moreover, the prophylactic medication regimens were recorded. Development of VTE was identified in patients, and a p-value <0.05 was considered statistically significant.  Results: A total of 327 patients were examined, of which 18 had developed VTE (5.5%). The frequency was relatively higher in males, cases with fractures, and cases with a history of VTE. Patients with two or more pelvic fracture sites and those with a history of VTE manifested  are statistically more likely to develop VTE than those with fewer than two pelvic fracture sites and no history of VTE (p-value = 0.02 and 0.006, respectively). Moreover, the administration of prophylactic doses of enoxaparin n had no statistically significant effect on VTE prevention (p-value = 0.08). Conclusion: In conclusion, we found no significant correlation between the prophylactic doses of enoxaparin and VTE probability. Furthermore, a history of VTE and more fracture sites would increase the probability of VTE.


M. Moini, M. R. Rasouli, A. Khaji, F. Farshidfar, and P. Heidari, "Patterns of extremity traumas leading to amputation in Iran: results of Iranian National Trauma Project," Chinese Journal of Traumatology (English Edition), vol. 12, pp. 77-80, 2009.

V. M. Nantulya and M. R. Reich, "The neglected epidemic: road traffic injuries in developing countries," BMJ: British Medical Journal, vol. 324, p. 1139, 2002.

W. H. Geerts, K. I. Code, R. M. Jay, E. Chen, and J. P. Szalai, "A prospective study of venous thromboembolism after major trauma," New England Journal of Medicine, vol. 331, pp. 1601-1606, 1994.

K. K. Søgaard, M. Schmidt, L. Pedersen, E. Horváth-Puhó, and H. T. Sørensen, "30-year mortality following venous thromboembolism: a population-based cohort study," Circulation, p. CIRCULATIONAHA. 114.009107, 2014.

M. G. Beckman, K. Abe, K. Barnes, B. Bartman, P. J. Brady, and W. C. Hooper, "Strategies and partnerships toward prevention of Healthcare‐Associated Venous Thromboembolism," Journal of Hospital Medicine, vol. 11, 2016.

S. P. Baker, B. o'Neill, W. Haddon Jr, and W. B. Long, "The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care," Journal of Trauma and Acute Care Surgery, vol. 14, pp. 187-196, 1974.

E. L. Hannan, C. H. Waller, L. S. Farrell, and C. G. Cayten, "A comparison among the abilities of various injury severity measures to predict mortality with and without accompanying physiologic information," Journal of Trauma and Acute Care Surgery, vol. 58, pp. 244-251, 2005.

O. B. Bolorunduro, C. Villegas, T. A. Oyetunji, E. R. Haut, K. A. Stevens, D. C. Chang, E. E. Cornwell, D. T. Efron, and A. H. Haider, "Validating the Injury Severity Score (ISS) in different populations: ISS predicts mortality better among Hispanics and females," Journal of surgical research, vol. 166, pp. 40-44, 2011.

B. L. Lobo, G. Vaidean, J. Broyles, A. B. Reaves, and R. I. Shorr, "Risk of venous thromboembolism in hospitalized patients with peripherally inserted central catheters," Journal of hospital medicine, vol. 4, pp. 417-422, 2009.

J. A. Caprini, "Thrombosis risk assessment as a guide to quality patient care," Disease-a-Month, vol. 51, pp. 70-78, 2005.

C. Huerta, S. Johansson, M.-A. Wallander, and L. A. G. Rodríguez, "Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom," Archives of internal medicine, vol. 167, pp. 935-943, 2007.

S. R. Shackford, J. W. Davis, P. Hollingsworth-Fridlund, N. S. Brewer, D. B. Hoyt, and R. C. Mackersie, "Venous thromboembolism in patients with major trauma," The American Journal of Surgery, vol. 159, pp. 365-369, 1990.

F. A. Anderson Jr and F. A. Spencer, "Risk factors for venous thromboembolism," Circulation, vol. 107, pp. I-9-I-16, 2003.

S. H. Norwood, C. E. McAuley, J. D. Berne, V. L. Vallina, D. B. Kerns, T. W. Grahm, and J. W. McLarty, "A potentially expanded role for enoxaparin in preventing venous thromboembolism in high-risk blunt trauma patients," Journal of the American College of Surgeons, vol. 192, pp. 161-167, 2001.

C. K. Walker, E. A. Sandmann, T. J. Horyna, and M. A. Gales, "Increased Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in General Trauma Patients," Annals of Pharmacotherapy, vol. 51, pp. 323-331, 2017.

J. W. Rostas, S. B. Brevard, N. Ahmed, J. Allen, D. Thacker, W. H. Replogle, R. P. Gonzalez, A. M. Frotan, and J. D. Simmons, "Standard dosing of enoxaparin for venous thromboembolism prophylaxis is not sufficient for most patients within a trauma intensive care unit," The American Surgeon, vol. 81, pp. 889-892, 2015.

J. M. Nunez, R. D. Becher, G. J. Rebo, J. P. Farrah, E. M. Borgerding, J. J. Stirparo, C. Lauer, P. Kilgo, and P. R. Miller, "Prospective evaluation of weight-based prophylactic enoxaparin dosing in critically ill trauma patients: adequacy of AntiXa levels is improved," The American Surgeon, vol. 81, pp. 605-609, 2015.

A. E. Berndtson, T. W. Costantini, J. Lane, K. Box, and R. Coimbra, "If some are good, more is better: an enoxaparin dosing strategy to improve pharmacologic venous thromboembolism prophylaxis," Journal of Trauma and Acute Care Surgery, vol. 81, pp. 1095-1100, 2016.

T. W. Costantini, E. Min, K. Box, V. Tran, R. D. Winfield, D. Fortlage, J. Doucet, V. Bansal, and R. Coimbra, "Dose adjusting enoxaparin is necessary to achieve adequate venous thromboembolism prophylaxis in trauma patients," The journal of trauma and acute care surgery, vol. 74, p. 128, 2013.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2022 Ostovari A et al.


Metrics Loading ...