The Clinical Analysis Of Low Molecular Weight Heparin Calcium Prophylaxis In Venous Thromboembolism After Multiple Trauma

Objective:to analyse the efficacy and the bleeding risk of low molecular weight heparin(LMWH) calcium with two administration methods in the prevention of venous thromboembolism(VTE) following multiple trauma.Method:According to two administration methods of LMWH calcium,130 cases of patients with multiple injuries receiving LMWH calcium prophylaxis are divided into Qd group and Q12h group,who were hospitalized in EICU, ICU and Department of orthopedic of the First Affiliated Hospital of Kunming Medical University during January 2012 to December 2014,and meet the inclusion criteria.Qd group:82 cases,0.4ml:4100AXaIU once daily;Q12h group:48 cases,0.4ml:4100AXaIU once per 12 hours;abdominal subcutaneous injection was administered in the both groups.To observe the incidences of VTE and bleeding complications in the both groups after treatment.Patients who developed VTE possibly received the diagnostic tests after treatment;DVT imaging diagnosis is based on color doppler ultrasound(CDUS);PE radiological diagnosis is based on spiral CT pulmonary angiography(CTPA).To observe the changes of platelet(PLT),prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB), fibrin(ogen) degradation products(FDP),d-dimer(D-D) and antithrombin HI(AT-in) in the both groups on the different time points before and after treatment(1 to 3 days before treatment(T1),1 to 3 days after treatment(T2),4 to 7 days after treatment(T3) and 8 to 14 days after treatment(T4)).To observe the situations of the main acquired risk factors which lead to the development of VTE in patients with VTE and patients without VTE following multiple trauma.Result:1.Qd group compared with Q12h group(1)The age,gender,ISS scores within 24 hours after trauma,APACHE II scores within 24 hours after admission,and the start time of administration in the both groups have no statistical differences(P>0.05).(2)The VTE incidence of Qd group is higher than Q12h group(19.51% vs. 12.500/o,respectively;P=0.031);the bleeding rate of Qd group is lower than Q12h group(4.88%vs.16.67%,respectively;P=0.025).(3)FDP is reduced with the extension of treatment time in the both groups(P< 0.001);FDP is lower in Q12h group than Qd group after treatment(P=0.045);but FDP is significantly higher than normal value in the both groups.(4)D-D is reduced with the extension of treatment time in the both groups(P< 0.001);D-D is lower in Q12h group than Qd group after treatment(P=0.034);but D-D is significantly higher than normal value in the both groups.(5)PLT is higher after treatment than before treatment and APTT is longer after treatment than before treatment in the both groups(P<0.05);compared with Q12h group,Qd group has no significant differences on both PLT and APTT(P> 0.05).Compared with before treatment,PT,TT,FIB and AT-ⅢI have no significant changes after treatment in the both groups(P<0.05);compared with Q12h group,Qd group has no significant differences on PT,TT,FIB and AT-EI(P>0.05).2.VTE group compared with non-VTE group(1)The age,gender,and the probability of surviving(Ps) on T1 in the both groups have no statistical differences(P>0.05).(2)According to the proportion of the main acquired risk factors in the both groups after multiple trauma,VTE group has orderly bedridden or long time immobilization,mechanical ventilation(>3 days),traumatic brain injury(AIS>3),lower limb fracture(AIS>3),major operation and spinal cord injury(SCI) form high to low;non-VTE group has orderly bedridden or long time immobilization,mechanical ventilation(>3 days),lower limb fracture(AIS>3),traumatic brain injur(AIS>3),major operation and thoracoabdominal injuries form high to low.Compared with non-VTE group,VTE group has no significant differences on the risk factors(P>0.05).Conclusion:Low molecular weight heparin calcium prophylaxis of the development of VTE following multiple injuries is that the administration method of 0.4ml:4100AXaIU once per 12 hours is significantly more effective than 0.4ml:4100AXaIU once daily in the anti-thrombotic effect;but the bleeding risk of the former is higher than the latter.