Venous Thromboembolism Prophylaxis in Trauma: Current Guidelines and Potential Advancements

Authors

• Christopher McCord, University of LynchburgFollow

Specialty

Trauma and Acute Care Surgery

Advisor

Dr. Nikoleta R. Delis

Abstract

This review evaluates current prophylactic guidelines, highlights limitations in existing evidence, and explores emerging strategies aimed at improving VTE prevention in trauma patients through personalized, evidence-based approaches. Venous thromboembolism (VTE) remains a major source of morbidity and mortality in hospitalized trauma patients. It is driven by traditional inpatient and surgical risk factors as well as trauma-induced coagulopathy (TIC), a complex process involving endothelial glycocalyx disruption, inflammatory activation, and coagulation pathway dysregulation. Reported VTE incidence varies widely across studies, likely reflecting differences in injury severity, operative intervention, timing of prophylaxis, and patient-specific risk factors. Current guidelines, including those from the Western Trauma Association and the American College of Surgeons, emphasize early initiation of low molecular weight heparin with dose adjustments based on certain patient specific risk factors. Despite these recommendations, VTE incidence remains substantial. Emerging approaches toward improving prophylaxis include thromboelastography (TEG)-guided dosing, factor XI inhibitors, and antithrombin III supplementation. Randomized trials evaluating TEG-guided dosing have not demonstrated significant reductions in VTE rates, underscoring the need for further investigation. Factor XI inhibitors have shown promising results in surgical populations but have not yet been evaluated in trauma patients. Similarly, while ex vivo and observational data suggest a potential role for antithrombin III supplementation, no randomized clinical trials have confirmed clinical benefit in trauma populations.

Recommended Citation

McCord C. Venous Thromboembolism Prophylaxis in Trauma: Current Guidelines and Potential Advancements. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).