ArticleThe journal of trauma and acute care surgery2018
Dynamic coagulability after injury: Is delaying venous thromboembolism chemoprophylaxis worth the wait?
Article in The journal of trauma and acute care surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07506473 (Intermediate Versus Standard Dose Enoxaparin to Prevent Venous Thromboembolism in Severe Trauma Patients), which is not on this map. Cited by 27 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Intermediate Versus Standard Dose Enoxaparin to Prevent Venous Thromboembolism in Severe Trauma Patients: a Multicenter Double Blind Randomised Controlled Trial
Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The 2023 WSES guidelines on the management of trauma in elderly and frail patients.World journal of emergency surgery : WJES · 2024Guideline
- Risk Factors for Preoperative DVT in Elderly Patients with Hip Fractures.Journal of clinical medicine · 2026Article
- Anatomic distribution and analysis of influencing factors on deep vein thrombosis in patients with spinal fractures caused by high-energy injuries.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Management Challenges in Trauma-Induced Coagulopathy: A Case Report of Hemothorax Requiring Reoperation.The American journal of case reports · 2024Article
- Nomogram for predicting postoperative deep vein thrombosis in patients with spinal fractures caused by high-energy injuries.Archives of orthopaedic and trauma surgery · 2024Article
- Efficacy of the bleeding risk scoring system for optimal prophylactic anticoagulation therapy of venous thromboembolism in trauma patients: a single-center, retrospective, observational cohort study.Journal of pharmaceutical health care and sciences · 2023Article
- Design and Development of a Clot Burst Pressure Device to Investigate Resuscitation Strategies.The Journal of surgical research · 2023Article
- Pulmonary embolism following severe polytrauma: a retrospective study from a level I trauma center in China.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Article
- Venous Thrombus Embolism in Polytrauma: Special Attention to Patients with Traumatic Brain Injury.Journal of clinical medicine · 2023Article
- Addition of aspirin to venous thromboembolism chemoprophylaxis safely decreases venous thromboembolism rates in trauma patients.Trauma surgery & acute care open · 2023Article
- Chemoprophylactic Anticoagulation 72 Hours After Spinal Fracture Surgical Treatment Decreases Venous Thromboembolic Events Without Increasing Surgical Complications.North American Spine Society journal · 2022Article
- Article
- Trauma-induced pulmonary thromboembolism: What's update?Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2022Review
- Observational
- Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy.Military Medical Research · 2021Article
- Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes.Medicines (Basel, Switzerland) · 2021Review
- A Stitch in Time Saves Clots: Venous Thromboembolism Chemoprophylaxis in Traumatic Brain Injury.The Journal of surgical research · 2021Article
- Weight-based enoxaparin with anti-factor Xa assay-based dose adjustment for venous thromboembolic event prophylaxis in adult trauma patients results in improved prophylactic range targeting.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2021Article
- Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document.Trauma surgery & acute care open · 2021Article
- Intramedullary Fixation Does Not Cause a Large Amount of Hidden Blood Loss in Elderly Patients with Intertrochanteric Fractures.Clinical interventions in aging · 2021Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundSeverely injured patients often progress from early hypocoagulable to normal and eventually hypercoagulable states, developing increased risk for venous thromboembolism (VTE). Prophylactic anticoagulation can decrease this risk, but its initiation is frequently delayed for extended periods due to concerns for bleeding. To facilitate timely introduction of VTE chemoprophylaxis, we characterized the transition from hypo- to hypercoagulability and hypothesized that trauma-induced coagulopathy resolves within 24 hours after injury.
methodsSerial blood samples were collected prospectively from critically injured patients for 120 hours after arrival at an urban Level I trauma center. Extrinsic thromboelastometry maximum clot firmness was used to classify patients as hypocoagulable (HYPO, <49 mm), normocoagulable (NORM, 49-71 mm), or hypercoagulable (HYPER, >71 mm) at each time point. Changes in coagulability over hospital course, VTE occurrence, and timing of prophylaxis initiation were analyzed.
results898 patients (median Injury Severity Score, 13; mortality, 12%; VTE, 8%) were enrolled. Upon arrival, 3% were HYPO (90% NORM, 7% HYPER), which increased to 9% at 6 hours before down-trending. Ninety-seven percent were NORM by 24 hours, and 53% were HYPER at 120 hours. Median maximum clot firmness began in the NORM range, up-trended gradually, and entered the HYPER range at 120 hours. Patients with traumatic brain injury (TBI) followed a similar course and were not more HYPO at any time point than those without TBI. Failure to initiate prophylaxis by 72 hours was predicted by TBI and associated with VTE development (27% vs 16%, p < 0.05).
conclusionsRegardless of injury pattern, trauma-induced coagulopathy largely resolves within 24 hours, after which hypercoagulability becomes increasingly more prevalent. Deferring initiation of chemoprophylaxis, which is often biased toward patients with intracranial injuries, is associated with VTE development. LEVEL OF EVIDENCE: Prognostic study, level III; Therapeutic, level IV.
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