Please chime in with your personal or institutional practices.
I'd like to know what most of us are doing to treat orthopaedic trauma patients with respect to initiating DVT/PE prophylaxis. Specifically, I mean to discuss patients with pelvic fractures/polytrauma whose plan includes an extended period of bedrest/immobilization. At the same time, I mean to exclude patients with brain or solid organ trauma.
1. How many hours after presentation do you wait to start LMWH?
2. How do you define "hemodynamically stable" as the criteria to starting LMWH? (i.e. how many hours of what H/H trend)
3. Does anyone advocate starting LMWH with pelvic fractures in the ER?
4. In whom do you choose to place a filter? How many hours after presentation?
Is anyone familiar with a 'comprehensive' algorithm to answer these questions? Most of what I have found only isolates subgroups and moreover tends to heavily favor a certain approach (e.g. early and frequent use of filters).
Thanks for any input.
