67 - OUTCOMES OF PROTOCOL-DRIVEN VENOUS THROMBOEMBOLIC CHEMO-PROPHYLAXIS IN TRAUMA PATIENTS: A TRAUMA QUALITY IMPROVEMENT PROJECT (TQIP) ANALYSIS

Objectives: Low molecular weight heparin (LMWH) is the standard for venous thromboembolic (VTE) chemo-prophylaxis in trauma patients; however, inconsistencies in the use of LMWH exist. The objective of this study was to assess VTE outcomes in response to a chemo-prophylaxis protocol guided by patient physiology (e.g. creatinine clearance) and comorbidities.

Methods: For Spring 2019 to Fall 2021, ACS TQIP Benchmark Reports at a level I trauma center using a patient physiology and comorbidity directed VTE chemo-prophylaxis protocol were analyzed. Patient demographics, VTE rates and pharmacologic VTE prophylaxis type were collected for “All Patients” and “Elderly” (TQIP: age ≥ 55 years) cohorts.

Results: Over the study period, data was collected and analyzed for 1,919,183 “All Hospitals” (AH) and 5843 patients single institution (SI) (median ISS, AH = 14 vs. SI =13; p = NS) using the physiologic and cormordity guided VTE chemo-prophylaxis protocol. Elderly subgroup had 701965 (AH) and 2939 (SI) patients. Use of non-LMWH chemo-prophylaxis was significantly higher at SI: All patients = 62.6% SI vs. 22.1% (p < 0.01); Elderly = 68.8% SI vs. 28.1% AH (p < 0.01). VTE, DVT, and PE rates for All Patients and Elderly subgroup were significantly reduced at SI except Elderly PE.

Conclusion: Protocol driven VTE chemo-prophylaxis was associated with significantly lower LMWH use accompanied by significant reductions in VTE and DVT rates and no difference in elderly PE. These results imply that adherence to protocolized chemo-prphylaxis, rather than strict adherence to LMWH, reduces VTE events in trauma patients. These results warrant further investigation to elucidate best practice.