(1023) Evaluation of an Updated Prophylaxis Guideline on Venous Thromboembolism Rates in Trauma Patients

Introduction: Hospitalized trauma patients are at increased risk of developing venous thromboembolism (VTE) which is associated with significant morbidity and mortality. The Western Trauma Association’s updated guidelines on chemical VTE prophylaxis recommend higher enoxaparin doses than previously used for trauma patients. The purpose of this analysis was to evaluate the differences in VTE rates in critically ill trauma patients between pre- and post-guideline update implementation.

Methods: This was a single-center, retrospective, pre-post analysis of trauma patients receiving chemical VTE prophylaxis admitted to the burn/trauma intensive care unit (ICU). Guideline update implementation occurred in September 2022. The pre group included patients from September to December 2021, and the post group included patients from September to December 2022. The major outcome was incidence of VTE, defined as deep venous thrombosis (DVT) or pulmonary embolism. A multivariate logistic regression analysis was performed to assess the effects of guideline implementation on the incidence of VTE when accounting for various confounders. Notable minor outcomes included the incidence of bleeding events and ICU length of stay (LOS).

Results: There were 227 patients who met criteria for inclusion. There were no statistically significant differences in baseline characteristics between groups, particularly in injury severity score and number of missed prophylaxis doses. There was no statistically significant difference in the incidence of VTE between the pre and post groups (7.2% vs 1.7%, p=0.075). The multivariate analysis showed guideline implementation was independently associated with a 97% reduced odds of VTE development (p=0.015) while a past medical history of DVT (p=0.008) and an initial contraindication to chemical VTE prophylaxis (p=0.016) were associated with an increased odds of VTE development. There were no statistically significant differences in the incidence of bleeding events or ICU LOS.

Conclusions: This analysis suggests the updated VTE prophylaxis guideline implementation was associated with a clinical trend toward reduced VTE development among critically ill trauma patients. Additional studies are needed to further characterize the impact of updated guideline implementation on VTE events in this population.