1. The 3-month symptomatic venous thromboembolism rate was 0.7% in patients with TRiP(cast) score < 7 and not receiving anticoagulation.

2. There was no significant difference between the control and intervention phases regarding secondary outcomes.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Venous thromboembolism (VTE) is a well-recognized potential complication resulting from orthopedic trauma and periods of prolonged immobilization. However, there exists a lack of consensus around prophylactic anticoagulation among patients with lower limb trauma requiring immobilization. This randomized controlled trial aimed to assess the safety of withholding anticoagulation for lower-risk patients with lower limb trauma based on the Thrombosis Risk Prediction for Patients with Cast Immobilization – TRiP(cast) scores. The primary outcome was the cumulative rate of VTE at three months, while key secondary outcomes were the incidence of major and non-major bleeding. According to study results, patients with TRiP(cast) score <7 reported a less than one percent risk of developing VTE which was lower than the prespecified cutoffs. Although this study was well done, it was limited by its focus on specific regions and settings, thus affecting the generalizability of results.

Click to read the study in The Lancet

Relevant Reading: Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture

In-depth [randomized-controlled trial]: Between Jun 16, 2020, and Sept 15, 2021, 25 clusters were assessed for eligibility across 15 emergency departments (EDs) in France and Belgium. Included were patients ≥ 18 years old who presented to ED with lower limb trauma requiring immobilization for ≥ 7 days. Altogether, 2120 patients were included in the final analysis, with 1505 in the intervention phase. The primary outcome concerning the 3-month cumulative rate of symptomatic VTE in patients with a TRiP(cast) score < 7 was 0.7% (95% confidence interval [CI] 0.3–1.4). In contrast, the 3-month rate of VTE in patients with a TRiP(cast) score ≥ 7 was 2.7% (95% CI 1.2–4.9) despite the use of anticoagulation. The secondary outcome, including bleeding rates, showed no significant difference between the control and intervention phases. Findings from this study suggest that withholding anticoagulation for lower-risk patients may be safe and reduce the need for thromboprophylaxis in patients following lower limb trauma.

Image: PD

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