Minor trauma and venous thromboembolism: the threshold for antithrombotic prophylaxis

Abstract

Trauma is an established risk factor for venous thromboembolism (VTE). Whether minor trauma is linked to greater risk of VTE remains unclear given that many studies evaluating trauma and VTE risk have not differentiated risk by trauma severity. Furthermore, the underlying risk of VTE is not uniform across all injured patients. While it is generally accepted that severely and moderately injured patients requiring prolonged hospitalization benefit from early and consistent administration of thromboprophylaxis, the threshold for its initiation following minor injury or in patients managed in an ambulatory setting is less clear. This review will describe how trauma is classified, summarize the evidence of the risk of VTE in patients with minor trauma, and guide clinicians through an approach to individualize these treatment decisions based on contemporary evidence. Guidance will be provided for both injured patients requiring hospitalization (who may have severe, moderate or minor trauma), and those suitable to be managed in an ambulatory setting (minor trauma).