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Age, severity of injury predict risk for VTE in certain immobilized patients
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Advancing age and injury severity appeared to be the only individual risk factors consistently associated with venous thromboembolism among individuals immobilized following a lower limb injury, according to results of a systematic review of several studies published in Journal of Thrombosis and Haemostasis.
“Our study is the first systematic review to assess the link between individual risk factors and all VTE, ie, symptomatic and/or asymptomatic, following temporary lower limb immobilization after injury,” Daniel Horner, MD, MBBS, professor in the school for health and related research at The University of Sheffield and Royal College of Emergency Medicine, and colleagues wrote. “This is an important distinction, as our population of interest differs from generic thrombosis datasets; patients with lower limb injury are potentially younger, more active and devoid of comorbidity than those presenting with other forms of VTE.”
Patients with a lower limb injury requiring immobilization — such as a cast or brace — are at risk for VTE. Different variations of thromboprophylaxis are used around the world in these patients; however, the accuracy of specific risk-based strategies is unknown.
In this study, Horner and colleagues analyzed 15 studies that reported data on 80,678 patients with or without VTE after lower limb immobilization. The analysis included 11 outpatient-based studies and four studies involving patients who had short-duration inpatient stays.
The mean age of patients in the studies ranged from 33.8 years to 52.6 years. The percentage of male patients ranged from 45.8% to 86.1% (median, 56.3%).
Researchers observed median prevalence of any VTE among patients of 4.8% (range, 0.22-23.5), and median prevalence of only symptomatic VTE of 2.9%.
The studies assessed risk factor associations through regression analyses, nonparametric tests and descriptive statistics. Researchers determined the methodological quality of each study using the ROBINS-I risk of bias tool.
Results showed age was the most consistent individual risk prediction factor for all VTE outcomes, reflected across 11 studies. ORs for age ranged from 1.95 to 3.48.
Six studies highlighted injury type as a risk factor, suggesting independent associations between severe traumatic injuries and fractures with increased risk for VTE.
All studies had a moderate to high probability of bias, which served as a limitation to the current study.
“Advancing age has long been recognized as an established risk for VTE,” Horner and colleagues wrote. “Our findings support this as one of the more reliable individual risk factors consistently demonstrating association with the likelihood of subsequent VTE. Causation in this study cannot be determined due to variable methodology.”– by John DeRosier
Disclosures: The United Kingdom National Institute for Health Research Health Technology Assessment Programme funded this study. The authors report no relevant financial disclosures.
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