Evaluation of a Venous Thromboembolism Prophylaxis Protocol for Trauma Patients

Introduction: Preventing venous thromboembolism (VTE) is an important factor in the care of trauma patients. In response to guideline changes and new evidence, Saint Luke’s Hospital (SLH) created a VTE prophylaxis protocol for trauma patients for enoxaparin based on injury and weight. The protocol generally recommends patients with high-risk VTE injuries receive enoxaparin 0.5mg/kg twice daily. The aim of this study was to evaluate VTE incidence before and after a risk-stratified, injury-guided, and weight-based VTE prophylaxis protocol implementation for trauma patients.


Methods: This was a retrospective pre/post VTE prophylaxis protocol implementation study evaluating VTE incidence in trauma patients at SLH from January 2021 to June 2024. Patients ≥18 years of age admitted to SLH trauma service were included. Patients who received therapeutic anticoagulation for an indication other than new VTE during admission, were evaluated by SLH trauma surgery staff with no evidence of traumatic injury, or who died within the first 24 hours of admission were excluded. The primary endpoint of this study was VTE incidence during hospitalization after implementation of the protocol compared to incidence before protocol implementation. Secondary endpoints of this study included clinically significant bleeding, achievement of goal peak prophylaxis anti-Xa levels with initial enoxaparin dosing, death within 90 days, ICU and hospital length of stay, and ICU readmission due to bleeding or VTE.


Results: There were 4,991 trauma patients included for analysis. The mean age overall was 66.0 ± 20.7; 62.0% with a high risk VTE injury and 32.9% with a high bleed risk injury. The incidence of VTE in the pre-protocol group was 0.9% as compared to 0.4% in the post-protocol group (n = 26 vs 3, p = 0.18). Safety outcomes related to clinically significant bleeding were similar between groups. No statically significant differences were observed between groups regarding hospital length of stay or inpatient mortality.


Conclusions: The incidence of VTE in trauma patients at SLH was lower after implementation of a risk-stratified, injury-guided, and weight-based VTE prophylaxis protocol.