Individual risk factors predictive of venous thromboembolism in patients with temporary lower limb immobilization due to injury: a systematic review
Author(s): ,
Daniel Horner
Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK. School for Health and Related Research, The University of Sheffield, Sheffield, UK. The Royal College of Emergency Medicine, London, UK
Correspondence: Daniel Horner, Emergency Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.|Tel.: +01 61 206 8793|E‐mail:
Abdullah Pandor
School for Health and Related Research, The University of Sheffield, Sheffield, UK
Steve Goodacre
School for Health and Related Research, The University of Sheffield, Sheffield, UK
Mark Clowes
School for Health and Related Research, The University of Sheffield, Sheffield, UK
Beverley J. Hunt
Thrombosis and Haemophilia Centre, St Thomas' Hospital, London, UK
ISTH Academy. Horner D.
Feb 8, 2019; 273375
Dr. Daniel Horner
Dr. Daniel Horner
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Journal Abstract
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Patients immobilized after lower limb injury are at risk of venous thromboembolism (VTE). There is international variation in the use of thromboprophylaxis for such patients. Risk‐based strategies have been adopted to aid decision making in many settings. The accuracy of these strategies is unclear.
A systematic review was undertaken to identify all individual patient‐identifiable risk factors linked to any VTE outcome following lower limb immobilization.
Several electronic databases were searched from inception to May 2017. Any studies that included a measurement of VTE as a patient outcome in adults requiring temporary immobilization (e.g. leg cast or brace in an ambulatory setting) for an isolated lower limb injury and reported risk factor variables were included. Descriptive statistics and thematic analysis were used to synthesize the evidence.
Our database search returned 4771 citations, of which 15 studies reporting outcome data on 80 678 patients were eligible for analysis. Risk‐factor associations were reported through regression analyses, non‐parametric tests and descriptive statistics. All studies were assessed as at moderate or serious risk of bias using the ROBINS‐I risk of bias tool.
Clinicians should be aware of the limited evidence to support individual risk factors in guiding thromboprophylaxis use for this patient cohort.
casts, immobilization, risk, surgical, venous thromboembolism
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