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Thromboprophylaxis in lower limb immobilisation after injury (TiLLI)
  1. Daniel Horner1,2,
  2. Steve Goodacre2,
  3. Abdullah Pandor2,
  4. Timothy Nokes3,
  5. Jonathan Keenan3,
  6. Beverley Hunt4,
  7. Sarah Davis2,
  8. John W Stevens5,
  9. Kerstin Hogg6
  1. 1Emergency Department, Salford Royal Hospitals NHS Trust, Salford, UK
  2. 2Centre for Urgent and Emergency Care Research (CURE), University of Sheffield, Sheffield, UK
  3. 3Departments of Haematology and Trauma/Orthopaedics, Plymouth Hospitals NHS Trust, Plymouth, UK
  4. 4Departments of Haematology and Rheumatology, Guy’s & St Thomas’s NHS Foundation Trust, London, UK
  5. 5Department of Health Economics and Decision Science, ScHARR, University of Sheffield, Sheffield, UK
  6. 6Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Daniel Horner, Salford Royal Hospitals NHS Trust, Salford M6 8HD, UK; danielhorner{at}nhs.net

Abstract

Venous thromboembolic disease is a major global cause of morbidity and mortality. An estimated 10 million episodes are diagnosed yearly; over half of these episodes are provoked by hospital admission/procedures and result in significant loss of disability adjusted life years. Temporary lower limb immobilisation after injury is a significant contributor to the overall burden of venous thromboembolism (VTE). Existing evidence suggests that pharmacological prophylaxis could reduce overall VTE event rates in these patients, but the proportional reduction of symptomatic events remains unclear. Recent studies have used different pharmacological agents, dosing regimens and outcome measures. Consequently, there is wide variation in thromboprophylaxis strategies, and international guidelines continue to offer conflicting advice for clinicians. In this review, we provide a summary of recent evidence assessing both the clinical and cost effectiveness of thromboprophylaxis in patients with temporary immobilisation after injury. We also examine the evidence supporting stratified thromboprophylaxis and the validity of widely used risk assessment methods.

  • thrombo-embolic disease
  • risk management
  • pulmonary embolism
  • musculo-skeletal, fractures and dislocations
  • cost effectiveness

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Footnotes

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  • Contributors DH and SG conceived the idea for this review and also acted as co-chief investigators for HTA 15/187/06. With regard to the wider project, AP was responsible for systematic review work; JWS was responsible for the statistical aspects; SD was responsible for the decision modelling and cost-effectiveness work; and TN, BH, KH and JK provided clinical expertise throughout the project. DH and SG were responsible for the drafting of this paper, although all authors provided comments on the drafts and read and approved the final version. DH is the guarantor for the paper.

  • Funding Much of the work cited in this review was funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number 15/187/06). The views expressed in this review are those of the authors and not necessarily those of the NIHR HTA Programme. Any errors are the responsibility of the authors. The funders had no role in the study design; collection, analysis and interpretation of data; writing of the manuscript; and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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