Drug prophylaxis of deep vein thrombosis in traumatology: is there a benefit of a score in outpatients?

Introduction: Guidelines are lacking for the administration of drug prophylaxis of deep vein thrombosis (DVT) in outpatients. This study attempted to develop such a guideline in the form of a score. Patients and methods: In a prospective study of 731 outpatients with injury or surgery of the leg or pelvis a score was assigned based on „simulated physiological conditions“ of the venous flow, including breathing, mobilization (activity of daily live), weight bearing and range of motion of joints of the lower extremities, lesions of the venous endothelium, date of injury, and localization of injury. The decision as to whether to administer drug prophylaxis of DVT was made on the basis of the patient's score. The venous system was investigated by duplex color-coded ultrasound. Results: There were two false-negative findings, meaning that patients without drug prophylaxis showed a thrombotic complication. In neither of these cases had the patient been compliant with medical instructions. In the group with drug prophylaxis there were 4% DVT (n=18). Conclusion: Compared to previous results of 10% DVT in outpatients, our score-assisted drug prophylaxis significantly reduced the incidence of DVT. The score also makes it possible to select patients not requiring drug prophylaxis. Received: 24 November 1997; in revised form: 14 August 1998 / Accepted: 28 August 1998