Journal Review in Trauma Surgery: VTE Prophylaxis

Venous thromboembolism (VTE) prophylaxis in high-risk trauma patients requires a multimodal approach beyond standard anticoagulation, as VTE rates remain high despite traditional protocols. Research indicates that adding aspirin to chemoprophylaxis regimens may reduce VTE risk, though patient populations in observational studies often vary significantly in injury severity. Dr. Bryan Cotton, a trauma surgery expert, emphasizes that trauma-induced acquired antithrombin deficiency frequently limits the efficacy of enoxaparin. Monitoring anti-factor Xa levels provides a more accurate assessment of anticoagulation responsiveness than standard tests, as many patients fail to achieve therapeutic ranges. Because antithrombin functions as the primary anticoagulant, its depletion in severely injured patients necessitates potential supplementation. Future clinical practice must move toward personalized, mechanism-based strategies, such as routine anti-factor Xa monitoring and targeted adjunct therapies, to improve outcomes in critically ill trauma populations.