TY - JOUR
T1 - Saudi Critical Care Society clinical practice guidelines on the prevention of venous thromboembolism in adults with trauma
T2 - reviewed for evidence-based integrity and endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine
AU - Amer, Marwa
AU - Alshahrani, Mohammed S.
AU - Arabi, Yaseen M.
AU - Al-jedai, Ahmed
AU - Alshaqaq, Hassan M.
AU - Al-Sharydah, Abdulaziz
AU - Al-Suwaidan, Faisal A.
AU - Aljehani, Hosam
AU - Nouh, Thamer
AU - Mashbari, Hassan
AU - Tarazan, Nehal
AU - Alqahtani, Saad
AU - Tashkandi, Wail
AU - Maghrabi, Khalid
AU - Albugami, Muneerah
AU - Hashim, Samaher
AU - Alsubaie, Norah M.
AU - Alsenani, Mohammad
AU - Algethamy, Haifa
AU - Alshammari, Thamir M.
AU - Alaklabi, Ali
AU - Ismail, Nadia
AU - Altawil, Esraa S.
AU - Elhazmi, Alyaa
AU - Nahhas, Ahmed
AU - Aljuaid, Maha
AU - Alsadoon, Naif
AU - Binbraik, Yasser
AU - Yuan, Yuhong
AU - Alhazzani, Waleed
N1 - Funding Information:
Guidelines reviewed by the SCCS. We thank GUIDE Group for providing logistic and statistical support. We are also thankful for Kaitryn Campbell, MSc MLS (St. Joseph’s Healthcare Hamilton, ON) for peer review of the MEDLINE search strategy. We gratefully acknowledge the contribution of Malak Alraygi, graphic designer, for the assistance in the infographic illustration.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/5/11
Y1 - 2023/5/11
N2 - Background: To develop evidence-based clinical practice guidelines on venous thromboembolism (VTE) prevention in adults with trauma in inpatient settings. Methods: The Saudi Critical Care Society (SCCS) sponsored guidelines development and included 22 multidisciplinary panel members who completed conflict-of-interest forms. The panel developed and answered structured guidelines questions. For each question, the literature was searched for relevant studies. To summarize treatment effects, meta-analyses were conducted or updated. Quality of evidence was assessed using the Grading Recommendations, Assessment, Development, and Evaluation (GRADE) approach, then the evidence-to-decision (EtD) framework was used to generate recommendations. Recommendations covered the following prioritized domains: timing of pharmacologic VTE prophylaxis initiation in non-operative blunt solid organ injuries; isolated blunt traumatic brain injury (TBI); isolated blunt spine trauma or fracture and/or spinal cord injury (SCI); type and dose of pharmacologic VTE prophylaxis; mechanical VTE prophylaxis; routine duplex ultrasonography (US) surveillance; and inferior vena cava filters (IVCFs). Results: The panel issued 12 clinical practice recommendations—one, a strong recommendation, 10 weak, and one with no recommendation due to insufficient evidence. The panel suggests starting early pharmacologic VTE prophylaxis for non-operative blunt solid organ injuries, isolated blunt TBIs, and SCIs. The panel suggests using low molecular weight heparin (LMWH) over unfractionated heparin (UFH) and suggests either intermediate–high dose LMWH or conventional dosing LMWH. For adults with trauma who are not pharmacologic candidates, the panel strongly recommends using mechanical VTE prophylaxis with intermittent pneumatic compression (IPC). The panel suggests using either combined VTE prophylaxis with mechanical and pharmacologic methods or pharmacologic VTE prophylaxis alone. Additionally, the panel suggests routine bilateral lower extremity US in adults with trauma with elevated risk of VTE who are ineligible for pharmacologic VTE prophylaxis and suggests against the routine placement of prophylactic IVCFs. Because of insufficient evidence, the panel did not issue any recommendation on the use of early pharmacologic VTE prophylaxis in adults with isolated blunt TBI requiring neurosurgical intervention. Conclusion: The SCCS guidelines for VTE prevention in adults with trauma were based on the best available evidence and identified areas for further research. The framework may facilitate adaptation of recommendations by national/international guideline policymakers.
AB - Background: To develop evidence-based clinical practice guidelines on venous thromboembolism (VTE) prevention in adults with trauma in inpatient settings. Methods: The Saudi Critical Care Society (SCCS) sponsored guidelines development and included 22 multidisciplinary panel members who completed conflict-of-interest forms. The panel developed and answered structured guidelines questions. For each question, the literature was searched for relevant studies. To summarize treatment effects, meta-analyses were conducted or updated. Quality of evidence was assessed using the Grading Recommendations, Assessment, Development, and Evaluation (GRADE) approach, then the evidence-to-decision (EtD) framework was used to generate recommendations. Recommendations covered the following prioritized domains: timing of pharmacologic VTE prophylaxis initiation in non-operative blunt solid organ injuries; isolated blunt traumatic brain injury (TBI); isolated blunt spine trauma or fracture and/or spinal cord injury (SCI); type and dose of pharmacologic VTE prophylaxis; mechanical VTE prophylaxis; routine duplex ultrasonography (US) surveillance; and inferior vena cava filters (IVCFs). Results: The panel issued 12 clinical practice recommendations—one, a strong recommendation, 10 weak, and one with no recommendation due to insufficient evidence. The panel suggests starting early pharmacologic VTE prophylaxis for non-operative blunt solid organ injuries, isolated blunt TBIs, and SCIs. The panel suggests using low molecular weight heparin (LMWH) over unfractionated heparin (UFH) and suggests either intermediate–high dose LMWH or conventional dosing LMWH. For adults with trauma who are not pharmacologic candidates, the panel strongly recommends using mechanical VTE prophylaxis with intermittent pneumatic compression (IPC). The panel suggests using either combined VTE prophylaxis with mechanical and pharmacologic methods or pharmacologic VTE prophylaxis alone. Additionally, the panel suggests routine bilateral lower extremity US in adults with trauma with elevated risk of VTE who are ineligible for pharmacologic VTE prophylaxis and suggests against the routine placement of prophylactic IVCFs. Because of insufficient evidence, the panel did not issue any recommendation on the use of early pharmacologic VTE prophylaxis in adults with isolated blunt TBI requiring neurosurgical intervention. Conclusion: The SCCS guidelines for VTE prevention in adults with trauma were based on the best available evidence and identified areas for further research. The framework may facilitate adaptation of recommendations by national/international guideline policymakers.
KW - Adult trauma patient
KW - GRADE
KW - Low molecular weight heparin
KW - Non-operative solid organ injuries
KW - Pharmacologic VTE prophylaxis
KW - Practice guidelines
KW - Spinal cord injury
KW - Traumatic brain injury
KW - Unfractionated heparin
KW - Venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85159150924&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85159150924&partnerID=8YFLogxK
U2 - 10.1186/s13613-023-01135-8
DO - 10.1186/s13613-023-01135-8
M3 - Review article
C2 - 37165105
AN - SCOPUS:85159150924
VL - 13
SP - 41
JO - Annals of Intensive Care
JF - Annals of Intensive Care
SN - 2110-5820
IS - 1
M1 - 41
ER -