Complications of anticoagulation for pulmonary embolism in low risk trauma patients

C. E.M. Brathwaite, A. J. Mure, Keith F. O'Malley, R. K. Spence, S. E. Ross

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Trauma patients are at significant risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). Anticoagulation is standard therapy for DVT/PE, but may cause severe complications. We reviewed the course of 70 trauma ICU patients treated over a 28-month period. Thirty-six patients (51.4 percent) were treated by continuous IV heparin and/or oral warfarin. Of these, 13 patients (36 percent) developed complications requiring termination of anticoagulation. These included recurrent PE (four), subdural hematomas (three), hemothorax (two), heparin-induced thrombocytopenia (one), hemorrhagic pericardial effusion (one), retroperitoneal hematoma (one), and sudden unexplained drop in hemoglobin and shock (one). All patients with subdural hematomas had no prior evidence of head injury on brain computed tomography. All patients with recurrent PE received adequate anticoagulation therapy. Age >55 was associated with increased risk of complications (8 of 13; p = .02:χ2). Thirty-four other patients (48.6 percent) received inferior vena caval filters with no related complications or deaths. Anticoagulation for DVT/PE should be used selectively in trauma patients and avoided in elderly patients. Such patients should undergo early caval filter placement.

Original languageEnglish (US)
Pages (from-to)718-720
Number of pages3
JournalChest
Volume104
Issue number3
DOIs
StatePublished - Jan 1 1993
Externally publishedYes

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Pulmonary Embolism
Wounds and Injuries
Venous Thrombosis
Subdural Hematoma
Venae Cavae
Heparin
Hemothorax
Pericardial Effusion
Warfarin
Craniocerebral Trauma
Thrombocytopenia
Hematoma
Shock
Hemoglobins
Tomography
Brain
Therapeutics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Complications of anticoagulation for pulmonary embolism in low risk trauma patients. / Brathwaite, C. E.M.; Mure, A. J.; O'Malley, Keith F.; Spence, R. K.; Ross, S. E.

In: Chest, Vol. 104, No. 3, 01.01.1993, p. 718-720.

Research output: Contribution to journalArticle

Brathwaite, C. E.M. ; Mure, A. J. ; O'Malley, Keith F. ; Spence, R. K. ; Ross, S. E. / Complications of anticoagulation for pulmonary embolism in low risk trauma patients. In: Chest. 1993 ; Vol. 104, No. 3. pp. 718-720.
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