Isolated distal DVT in trauma: A study of the management of isolated distal deep vein thrombosis acquired as an inpatient in trauma patients

Background: Isolated distal deep vein thromboses (IDDVT) are common complications of trauma inpatient admission, however their management is controversial. We aimed to analyse outcomes in patients admitted to a level three tertiary referral centre who received therapeutic anticoagulation compared to those that did not. We hypothesised that therapeutic anticoagulation would be safe and effective in trauma inpatients who develop IDDVT. Methods: We performed a review of the electronic case notes of all patients with venous thromboembolism listed as a complication whilst admitted as an inpatient under the trauma unit at a tertiary institution over a 4-year period, from October 2014 to October 2018. Demographic data was collected, as well as data regarding management, major bleeding and progression of thrombosis to proximal DVT or PE. Results: 91 IDDVT in trauma inpatients were identified. 33 patients received therapeutic anticoagulation within seven days of their diagnosis. No major bleeding was observed in this group, while one episode of thrombus progression was observed. 58 patients were not given therapeutic anticoagulation within seven days of IDDVT diagnosis. There were seven episodes of thrombus progression in this group on median day 5 post diagnosis, while no major bleeding was observed. Conclusion: Only approximately 1/3rd of patients with IDDVT after trauma received therapeutic anticoagulation, and in these selected cases it appears safe. Those who did not receive therapeutic anticoagulation had a significant rate of thrombosis extension into the proximal system and pulmonary embolus. Further studies on correctly identifying who can be safely anticoagulated are required and for those who cannot be, these data show more aggressive surveillance and prophylaxis needs to be considered.