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Invited Commentary
October 19, 2016

Optimizing Venous Thromboembolic ProphylaxisIs Thromboelastography the Answer?

Author Affiliations
  • 1Department of Surgery, Madigan Army Medical Center, Tacoma, Washington
JAMA Surg. 2016;151(10):e162081. doi:10.1001/jamasurg.2016.2081

Despite being one of the more common sources of morbidity and mortality among critically ill or injured patients, venous thromboembolic disease (VTE) remains poorly understood, inadequately characterized, and minimally responsive to both mechanical and pharmacologic prophylaxis. As a result, approaches to prevention and diagnosis of VTE can fairly be categorized as ranging from fanaticism to nihilism, with most practitioners (including this author) falling somewhere in the middle. However, this should not stop one from appreciating the valid points and hard data that exist in support of each extreme of this spectrum.14 The trauma and critical care communities have adopted a relatively uniform approach to VTE prophylaxis, despite the weakness and wide variability in the published evidence. This typically includes a combination of mechanical methods with either unfractionated heparin or low-molecular-weight heparin (LMWH), which are further confounded by issues with delayed initiation, missed or held doses, and variability in the dose and administration schedule.

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