VENOUS THROMBOEMBOLISM PROPHYLAXIS WITH LOW MOLECULAR WEIGHT HEPARINS IN POLYTRAUMATIZED PATIENTS IN INTENSIVE CARE UNIT
MEHMET KURTOĞLU, C DİNÇAY BÜYÜKKURT, A CEM DURAL, METİN KURTOĞLU, RECEP GÜLOĞLU
İstanbul Tıp Fakültesi, Genel Cerrahi ABD, İSTANBUL
Pulmonary Embolism is a major cause of death in trauma patients in ICU. Without prophylaxis the incidence of PE has been found as 50-60% depending on the severity of trauma. The use of LMWH has gained popularity for reducing the risk of VTE over the last 10 years. In trauma patients, LMWH has better efficiency than unfractionned heparin and similar efficiency to sequential compression, with similar bleeding risk when used for VTE prophyloxis. Alternative prophylaxis methods or no application of prophylaxis, in such a high risk group, as ICU patients were considered unethical, therefore there was no control group. In our study we aimed to evaluate, retrospectively, the bleeding and the VTE complications intrauma patients in ICU under the prophylaxis of enoxaparin sodium. The results will guide us to establish a protocol for the use of enoxaporin sodium in trauma patients, 397 polytraumatized patients treated in ICU are included to the study group. All patients received 40 mg/day of enoxaparin sodium. Severity of trauma was guantified with Apache II Scoring System and the diagnosis of bleeding was made by observing a sudden drop of 2g/dl in hemoglobin concentration whereas pulmonary embolism was diagnosed with a sudden change in blood gases and deterioration of the clinical outlook which was confirmed by a spiral CT scan. Spiral CT scan or radionucleotide ventilation perfusion scan could not be performed in all cases due to difficulities confronted in the application of these procedures in ICU patients. Statistical correlation was made by Pearson's correlation test. Mean Apache II score was 13.8 with a total mortality of 41%. 40 patients (10%) had bleeding due to enoxiparine prophylaxis. 11 patients (2.8%) had pulmonary embolism and 7 of them (63 %) had died, in conclusion polytraumatized patients need prophylaxis since as approved by the literature LMWH significantly reduces PE incidence in polytraumatized patients. On the other hand, the bleeding risk has slightiy increased without showing any significance (p>0.05). Prophylaxis with 40mg/day Enoxaparin sodium is safe and efficient.
Keywords: POLYTRAUMA, INTENSIVE CARE UNIT, PULMONARY EMBOLISM, PROPHYLAXIS, LOW MOLECULAR WEIGHT HEPARIN