What is it about?

Pulmonary embolism secondary to trauma is the third commonest cause of death in trauma patients who have survived 24h following injury. We describe a case of pulmonary embolism (PE) which occurred within three hours after major trauma in a previously well adolescent female. Timing of the occurrence of PE in this case is at odds with what is generally reported after major trauma.

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Why is it important?

General consensus has been that patients who suffer major trauma move from an initial hypocoaguable state, with increased risk of bleeding, to normo- or hypercoaguable states, with a subsequent increased risk of venothromboembolism. However, Sumislawski et al recently demonstrated that a marginally greater proportion of trauma patients were in fact hypercoaguable rather than hypocoaguable upon arrival to hospital and that trauma-induced coagulopathy (TIC) tended to resolve within 24 hours; such data causes us to re-evaluate when to commence thromboprophylaxis for major trauma patients.

Perspectives

• Evidence suggests that there is a significant number of trauma patients in a hypercoagulable state early after trauma. • Potential benefit of an earlier than usual thromboembolic prophylaxis in this group of patients might exist. • Identification of patients at risk of early thromboembolism including PE after major trauma is a challenge, which requires further research.

PASCHALITSA SERCHAN
Cork University Hospital of Ireland

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This page is a summary of: Pulmonary embolism occurring early after major trauma, BMJ Case Reports, September 2019, BMJ, DOI: 10.1136/bcr-2018-228783.
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