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Article Dans Une Revue Annales françaises de médecine d'urgence Année : 2021

Venous Thromboembolic Risk in Patients with Lower Limb Trauma Requiring Immobilization: Towards an Individualized Approach

Résumé

Lower limb trauma requiring immobilization is a situation at risk of developing venous thromboembolic (VTE) disease. However, recommendations and practices vary significantly from country to country and from center to center. The aims of this narrative review are to describe the epidemiology, prevention, and prediction algorithms for venous thromboembolic disease in patients with lower limb trauma requiring immobilization. The incidence of VTE varies between studies due to the great heterogeneity of the patients included (from ankle sprains to major injuries requiring surgery) and due to the heterogeneity of the evaluation criteria (consideration of asymptomatic proximal or distal or only symptomatic thrombosis). The estimated incidence of symptomatic venous thromboembolic events is 2.0% (95% confidence interval: 1.3 to 2.7). The efficacy of thromboprophylaxis has been confirmed in two meta-analyses that included randomized controlled trials. However, these results had to be carefully interpreted because many trials had methodological flaws. The largest and most recent study showed no benefit of low molecular weight heparin prevention on symptomatic events in an unselected population. These results suggest adopting a personalized strategy, keeping prophylaxis for at-risk patients. Several scores are currently being proposed to assess individual thromboembolic risk. Considering the characteristics of the patient, the trauma, and the immobilization, it is possible to identify a large subgroup of patients in whom prevention seems useless and a subgroup of high-risk patients in whom prevention should be prescribed or even reinforced. In conclusion, in the case of lower limb trauma requiring immobilization, the indication for thromboprophylaxis should be guided by the individual assessment of thrombotic risk.

Dates et versions

hal-03476786 , version 1 (13-12-2021)

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Citer

D. Douillet, T. Barbere, M. Peintre, T. Moumneh, F. Morin, et al.. Venous Thromboembolic Risk in Patients with Lower Limb Trauma Requiring Immobilization: Towards an Individualized Approach. Annales françaises de médecine d'urgence, 2021, 11 (5), pp.311-319. ⟨10.3166/afmu-2021-0345⟩. ⟨hal-03476786⟩
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