A number of the "bust my leg ski-ing on the continent" patients seem to
arrive in a cast and on LMWH. I've asked our pods and medics about risk-
benefit of continuing LMWH. Universal shrug of shoulders and "I dunno".
So I don't, as its not standard practice. This is as usual, far from
evidence-based.
A brief visit to bandolier, Clinical Evidence, Bestbets and Pubmed
reveals a wealth of material on DVT prophylaxis for peri-operative
patients with various fractures (mostly hip / pelvis), but nothing on
non-operatively managed lower leg fractures.
There must be something published for such a common condition (lower leg
#s) with such a serious and potentially preventable complication. If
not, perhaps someone should do the study!
Goat
In message <[log in to unmask]>, Jonathan
Benger <[log in to unmask]> writes
> We recently had a very upsetting case of middle aged man, with no
> apparent risk factors for venous thrombo-embolic disease, who
> re-presented to our ED with a fatal PE 5 days after attending for
> repair of a lower leg laceration. He had been resting at home. I
> note a similar report in the latest edition of the MPS casebook.
>
> Clearly, there is an enhanced risk of PE following POP
> immobilisation. Anecdotes aside, however, I have no idea what the
> risk benefit ratio of LMWH would be. Also, the logistics of
> anticoagulating every person in a lower limb cast are extremely
> daunting.
>
> Jonathan Benger
> Bristol Royal Infirmary
>> -----Original Message-----
>> From: Accident and Emergency Academic List
>> [mailto:[log in to unmask]]On Behalf Of Sunil Dasan
>> Sent: 07 February 2005 17:19
>> To: [log in to unmask]
>> Subject: DVT prophylaxis and POP casts
>
>
>> Is anyone aware of any literature relating to the pros and cons
>> of starting DVT prophylaxis in patients at potential risk of DVT
>> who are going into a below knee POP /Backslab? Had a recent
>> case of a patient who had an ankle fracture, POP and then
>> developed pleuritic chest pain. Fortunately wasn't a PE but the
>> question of whether we should be starting LMWH on these patients
>> has been raised.
>
>
>>
>
>
>> Sunil
>
>
>> Redhill
>
>
>>
>
>
>>
>
>
>
>> http://www.surreyandsussex.nhs.uk
>
>
>
>> DISCLAIMER: Unless expressly stated otherwise, the information
>> contained in this e-mail is confidential and is intended only
>> for the named recipient(s). If you are not the intended
>> recipient you must not copy, distribute, or take any action or
>> reliance upon it. If you have received this e-mail in error,
>> please notify the sender. Any unauthorised disclosure of the
>> information contained in this e-mail is strictly prohibited.
--
Goat
|