Use of low-molecular-weight heparin and a deep vein thrombosis protocol to prevent DVT in elderly patients with trauma.

Thromboembolic events (TEs), including pulmonary embolisms (PEs), are life threatening. Older patients with trauma are at significantly higher risk for these complications. In March 2003, a deep vein thrombosis (DVT) prophylaxis protocol was implemented for use in all trauma patients admitted to our hospital. Here we report on the results of using this protocol for patients aged 65 years or older. A risk-stratified DVT/PE prophylaxis protocol was developed, incorporating specific injuries and history and physiologic parameters, which favored aggressive therapy and included patients at highest risk for dying from PEs. Between March 2003 and June 2005, these data were collected on all trauma patients admitted to our level I hospital. Comparisons were made with historical controls (patients admitted in 2002, before implementation of this protocol). TE rates for the study period trended lower for patients aged 65 or older (6.4% vs 2.2%, P<.1). This protocol did not increase the incidence of bleeding events in this patient population. Protocol-based, risk-adjusted DVT/TE prophylaxis is safe and efficacious in elderly trauma patients who are at increased risk for TEs.