Saudi Critical Care Society clinical practice guidelines on the prevention of venous thromboembolism in adults with trauma: reviewed for evidence‑based integrity and endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Annals of Intensive Care, 2023 · DOI: https://doi.org/10.1186/s13613-023-01135-8 · Published: January 17, 2023

Cardiovascular Science Critical Care Trauma

Simple Explanation

These guidelines provide recommendations for preventing venous thromboembolism (VTE) in adults hospitalized with major trauma. They are intended for clinicians, allied health professionals, and policymakers involved in trauma care. The guidelines development involved a multidisciplinary panel that formulated questions, searched relevant literature, conducted meta-analyses, and assessed the quality of evidence using the GRADE approach. The panel issued 12 recommendations, including one strong recommendation, ten weak recommendations, and one with no recommendation due to insufficient evidence.

Study Duration

Not specified

Participants

Multidisciplinary panel of 22 experts

Evidence Level

GRADE approach

Key Findings

1
Early pharmacologic VTE prophylaxis is suggested for non-operative blunt solid organ injuries, isolated blunt TBIs, and SCIs.
2
LMWH is suggested over UFH for pharmacologic VTE prophylaxis, with options for intermediate–high dose or conventional dosing LMWH.
3
Mechanical VTE prophylaxis with IPC is strongly recommended for trauma patients who are not candidates for pharmacologic VTE prophylaxis.

Research Summary

The SCCS guidelines for VTE prevention in adults with trauma were developed using the best available evidence and identify areas for future research. The guidelines cover various aspects of VTE prophylaxis, including timing, type, dose, and mechanical methods, tailored to specific trauma types such as blunt solid organ injuries, TBIs, and SCIs. The recommendations aim to provide guidance to clinicians and policymakers and may facilitate adaptation of VTE prevention strategies at national and international levels.

Practical Implications

Early VTE Prophylaxis

Implementing early pharmacologic VTE prophylaxis in specific trauma populations can reduce VTE risk.

LMWH over UFH

Adopting LMWH as the preferred pharmacologic agent can improve outcomes compared to UFH.

Mechanical Prophylaxis Implementation

Utilizing mechanical VTE prophylaxis for patients ineligible for pharmacologic methods is crucial for VTE prevention.

Study Limitations

1
Ambiguity surrounding the definition of “early” versus “delayed” initiation of VTE prophylaxis.
2
Limited prospective evidence on the topic.
3
The evidence supporting VTE prophylaxis in adults with trauma does not provide high quality of effects for many critical and important outcomes

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