Venous thromboembolism prophylaxis for patients receiving regional anesthesia following injury in Iraq and Afghanistan

Aaron B. Holley, Sarah Petteys, Joshua D. Mitchell, Paul R. Holley, Jordanna M. Hostler, Paul Clark, Jacob F. Collen

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3 Scopus citations


BACKGROUND: Soldiers with combat-related traumatic injury are at high risk for venous thromboembolism (VTE) and often require regional anesthesia (RA) for pain control. We evaluated whether the recommended reduction in chemoprophylaxis in the presence of RA increases VTE rates. METHODS: We collected data each hospital day for all soldiers admitted to theWalter Reed Army Medical Center following injury in Iraq or Afghanistan.We analyzed thromboprophylaxis and RA rates and assessed risk factors for VTE.We separated outcomes by whether RA was central neuraxial (cNAB) or peripheral blockade. RESULTS: Among 1,259 patients, 323 received RA for a median of 12 days (5Y27 days). Those with RAwere younger and more likely to have been injured in combat or by an improvised explosive device. They also received more packed red blood cell transfusions and had longer admissions. Patients with RA spent a greater percentage of days on enoxaparin 40 mg daily compared with those without RA (34.4% vs. 22.0%, p > 0.001) and more hospital days without any chemoprophylaxis (2.0 [1.0Y6.0] vs. 1.0 [0.0Y3.0], p > 0.001). Patients with cNAB were less likely to be placed on enoxaparin 30 mg twice daily. Patients with RA in place had mechanical prophylaxis ordered at the same rate as those without RA. Neither the presence of any RA nor cNAB specifically was associated with an increased risk for VTE. No bleeding or neurologic complications occurred in those receiving RA. CONCLUSION: Despite changes to chemoprophylaxis, soldierswounded in combatwho receiveRAare not at increased risk for VTE.

Original languageEnglish
Pages (from-to)152-159
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Issue number1
StatePublished - Jan 2014
Externally publishedYes


  • Epidural hematoma
  • Neuraxial blockade
  • Thromboembolism
  • Thromboprophylaxis
  • Venous thromboembolism


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