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Upper extremity injury not a risk factor for VTE in lower extremities, study finds
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Investigators from Philadelphia have found similar rates of lower extremity venous thromboembolism among patients who have sustained an upper extremity injury and those who have not.
The team found no evidence for major upper extremity orthopedic trauma as an independent risk factor for venous thromboembolism (VTE) in the lower extremities, and added they believe their institution’s current VTE prophylaxis clinical practice guidelines should not be altered for patients with major upper extremity injury.
“The impetus for our study came from our observation that a number of patients at our institution sustaining upper extremity injury developed acute [deep vein thrombosis] and even fatal pulmonary embolism,” lead author Jason E. Hsu, MD, told Orthopedics Today. “On review of the literature, there was no substantial evidence supporting or rejecting the use of more aggressive VTE prophylaxis for this group of patients.”
Retrospective review
Hsu and colleagues retrospectively reviewed 11 years of data collected from the trauma registry at their level 1 trauma center. From a database consisting of 4,706 patients with blunt trauma, the team identified 646 patients with major upper extremity trauma who fit the inclusion criteria, 32 of which also developed thromboembolic complications. Hsu’s team selected 32 injury-matched controls from the original group of 646 patients and applied regression analysis to identify variables significantly associated with lower extremity thromboembolic complications.
The group found a 4.95% overall incidence rate of VTE — 4.64% deep vein thrombosis and 0.31% pulmonary embolism — in patients who sustained an upper extremity injury, which the investigators noted was similar to the 4.95% VTE rate identified in patients who did not sustain an upper extremity injury. None of the patients with isolated upper extremity trauma had VTE complications.
The group also noted that major head injury rates were higher in the cohort of patients with VTE.
“The increased incidence of VTE in patients with head trauma has been reported previously,” Hsu noted, adding there are numerous reasons for this connection. “Head trauma often leads to increased lengths of immobilization. Also, chemical prophylaxis is often contraindicated in patients with intracranial hemorrhage.”
Take-home message
Greater length of hospital stay and time spent on a ventilator were also associated with significantly higher risks of thromboembolic complications.
“The take-home message of our study is that upper extremity injuries did not warrant more aggressive VTE prophylaxis at our institution,” Hsu concluded. “Based on our data, we did not find a compelling reason to change our current clinical practice guidelines for VTE prophylaxis in patients with upper extremity injuries. Theoretically, additional interventions for those patients with [upper extremity] injury may be unwarranted and could potentially lead to unnecessary bleeding complications such as surgical site hematomas, gastrointestinal hemorrhage, etcetera.” – by Robert Press
Reference:
- Hsu JE, Namdari S, Baldwin KD, et al. Is upper extremity trauma an independent risk factor for lower extremity venous thromboembolism? An 11-year experience at a level 1 trauma center. Arch Orthop Trauma Surg. 2011. doi: 10.1007/s00402-010-1094-3.
- Jason E. Hsu, MD, can be reached at the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 34th and Spruce, 2nd Floor, Silverstein Building, Philadelphia, PA 19104; email: jason.hsu@uphs.upenn.edu.
- Disclosure: Hsu has no relevant financial disclosures.