■建议在绝大多数创伤患者中预防静脉血栓栓塞(VTE)。这项研究的目的是描述当前的给药实践和在创伤中心开始药理学VTE化学预防的时机。
■这是一个国际性的,创伤提供者的横断面调查。该调查由美国创伤外科协会(AAST)赞助,并分发给AAST成员。调查包括38个关于从业者人口统计学的问题,经验,创伤中心的水平和位置,以及关于剂量的个人/特定地点实践,选择,创伤患者开始药物VTE化学预防的时机。
■118个创伤提供者做出了回应(估计反应率为6.9%)。大多数受访者在一级创伤中心(100/118;84.7%),经验>10年(73/118;61.9%)。虽然使用了多种给药方案,报告的最常见剂量为依诺肝素30mg/12小时(80/118;67.8%).大多数受访者(88/118;74.6%)表示调整肥胖患者的剂量。78例(66.1%)常规使用抗因子Xa水平来指导给药。与非学术中心的受访者相比,学术机构的受访者更有可能使用指南指导的剂量(基于东部创伤手术协会和西部创伤协会指南)的VTE化学预防(86.2%vs62.5%;p=0.0158),如果创伤团队包括临床药剂师,则指南指导的剂量报告更频繁(88.2%vs69.0%;p=0.0142)。创伤性脑损伤后VTE化学预防的初始时机差异很大,实体器官损伤,脊髓损伤被发现.
■在预防创伤患者VTE的处方和监测实践中存在高度变异性。临床药师可能有助于创伤团队优化剂量并增加指南一致的VTE化学预防的处方。
UNASSIGNED: Pharmacological venous thromboembolism (VTE) prophylaxis is recommended in the vast majority of trauma patients. The purpose of this study was to characterize current dosing practices and timing of initiation of pharmacological VTE chemoprophylaxis at trauma centers.
UNASSIGNED: This was an international, cross-sectional survey of trauma providers. The survey was sponsored by the American Association for the Surgery of Trauma (AAST) and distributed to AAST members. The survey included 38 questions about practitioner demographics, experience, level and location of trauma center, and individual/site-specific practices regarding the dosing, selection, and timing of initiation of pharmacological VTE chemoprophylaxis in trauma patients.
UNASSIGNED: One hundred eighteen trauma providers responded (estimated response rate 6.9%). Most respondents were at level 1 trauma centers (100/118; 84.7%) and had >10 years of experience (73/118; 61.9%). While multiple dosing regimens were used, the most common dose reported was
enoxaparin 30 mg every 12 hours (80/118; 67.8%). The majority of respondents (88/118; 74.6%) indicated adjusting the dose in patients with obesity. Seventy-eight (66.1%) routinely use antifactor Xa levels to guide dosing. Respondents at academic institutions were more likely to use
guideline-directed dosing (based on the Eastern Association of the Surgery of Trauma and the Western Trauma Association
guidelines) of VTE chemoprophylaxis compared with those at non-academic centers (86.2% vs 62.5%; p=0.0158) and
guideline-directed dosing was reported more often if the trauma team included a clinical pharmacist (88.2% vs 69.0%; p=0.0142). Wide variability in initial timing of VTE chemoprophylaxis after traumatic brain injury, solid organ injury, and spinal cord injuries was found.
UNASSIGNED: A high degree of variability exists in prescribing and monitoring practices for the prevention of VTE in trauma patients. Clinical pharmacists may be helpful on trauma teams to optimize dosing and increase prescribing of
guideline-concordant VTE chemoprophylaxis.