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Three Part Question

In [patients with a recent significant lower limb trauma about to fly] is [prophylaxis with aspirin or low molecular weight heparin] indicated [to reduce the incidence of deep vein thrombosis]?

Clinical Scenario

A 21 year old medical student presents to the Emergency Department 4 hours before he is due to take a flight to Florida for a 2 week holiday. Six weeks ago he was involved in a motorcycle accident in which he sustained a midshaft closed fracture of his left tibia and fibula. He has made an uneventful recovery but is still in plaster. The airline has given him the all clear to fly, however he is still concerned about the possibility of developing a DVT. You wonder whether it would be beneficial to give him prophylaxis with aspirin or low molecular weight heparin (LMWH).

Search Strategy

Medline 1950 – week 3 November 2008 using the OVIDSP interface.
[{exp pulmonary embolism or pulmonary embol$.mp or PE.mp or exp thromboembolism or pulmonary infarct$.mp or exp Venous Thrombosis or dvt.mp or deep vein thrombosis.mp} AND {prophylaxis.mp or exp Heparin or exp Heparin, Low-Molecular-Weight or heparin.mp or aspirin.mp or exp Aspirin } AND {fracture.mp. or exp Fracture Healing or trauma.mp. or exp "Wounds and Injuries" or exp Casts, Surgical or plaster.mp or wound$.mp or injur$.mp.} AND { fly.mp and flight$.mp and exp Aviation or aviation.mp or travel.mp. or exp Travel}]

Search Outcome

14 papers were found of which none were relevant.

Comment(s)

There is a need for more research to address the specific question of management of high-risk patients.

Clinical Bottom Line

Each case needs to be assessed individually for degree of clinical risk.