Background. The incidence of venous thromboembolic complications (VTEC) in the wounded remains high and reaches 28%. Therefore, the problems pertaining to their prevention are currently important for modern healthcare.
Objective. The aim of our investigation was to study the incidence and methods of preventing VTEC in victims with combat gunshot injury inflicted during a special military operation.
Patients and methods. We analyzed the results of treating a total of 98 wounded patients recently admitted to the Chief Military Clinical Hospital of the Russian National Guard Troops with a combat gunshot injury inflicted while performing service and combat missions.
All victims were men, average age 32.4±4.3 years. The mean severity of injuries on the ISS scale was 8.8±1.3 points, on the national Military Field Surgery (Gunshot Wound) scale MFS (GW) – 2.2±0.3 points.
Depending on the severity of injuries sustained, the wounded were divided into 2 groups. Group I included 55 (56.1%) patients with ISS ≤6, and Group II comprised 43 (43.9%) patients with ISS >6.
For Group I patients, anticoagulant drugs were prescribed in prophylactic dosages only in the presence of extensive soft tissue injuries in the projection of blood vessels, injuries to the major veins with no risk of bleeding, as well as when bed rest was prescribed. Elastic bandages and intermittent pneumatic compression (IPC) were prescribed according to indications.
All Group II wounded patients were prescribed anticoagulant therapy in prophylactic dosages, with mechanical methods used to accelerate venous blood flow: elastic bandages, IPC, electrical myostimulation (including cases with external fixation devices applied). Surgical prevention of VTE consisted in placing a removable vena cava filter in the infrarenal portion of the inferior vena cava, followed by its removal after resolution of embolic thrombosis.
Results. The average length of hospital stay in Group I was 26.7±2.1 bed days and in Group II 45.7±3.2 bed days (p<0.001).
A statistically significant relationship was revealed between the severity of the injury and the incidence of deep vein thrombosis (DVT) – a significant increase in the number of DVTs in Group II compared with Group I (χ2=10.2; p<0.002). It was found that with ISS >6, the risk of developing VTEC in Group II patients was 4.5-fold higher (95% CI: 1.6–12.6; p=0.003) than in Group I patients with the severity of injuries according to ISS ≤6; DVT of the lower extremities developed in 77.8% of cases with ISS >6.
Floating thrombi were detected in 4 (4.1%) and pulmonary embolism in 3 (7%) patients of Group II. Six (14%) Group II wounded patients developed VTEC during a course of standard pharmacoprophylaxis.
Conclusion. The incidence of VTEC in wounded people in modern armed conflict is 18.4%. Of these, VTEC develops in 7.3% of victims with ISS ≤ 6 and in 32.6% – with ISS >6. For wounded patients with ISS ≤6, VTEC prophylaxis is indicated in case of extensive damage to the soft tissues of the extremities in the projection of the vessels, in case of injury to the main veins of the extremities and the prescription of bed rest.
It is advisable to classify wounded patients with ISS >6 and a score of 11 or greater on the Caprini scale into a group of very high risk of developing VTEC. The basis for the prevention of VTEC in this group is the noctidial use of IPC or electrical myostimulation, with the prescription of conventional anticoagulant therapy in the absence of hemorrhagic complications.
Funding. The study had no financial support.
Conflict of interest. The authors declare no conflicts of interest.
Authors’ contribution. Study conception and design – Nikolaev K.N., Ivchenko D.R., Zubritsky V.F.; data collection and handling – Chevychelov S.V., Nikolaeva G.K., Arefieva T.A., Kukushkina E.A., Zherebtsov A.I., Anishchenko V.V., Fedosov M.V.; statistical processing – Nikolaev K.N., Akimov A.V.; draft manuscript preparation – Nikolaev K.N., Golubov E.A., Kovalev A.S.; manuscript revision – Zubritsky V.F., Ivchenko D.R., Akimov A.V., Vardanyan A.V.
For citation: Nikolaev K.N., Chevychelov S.V., Ivchenko D.R., Akimov A.V., Golubov E.A., Anishchenko V.V., Kovalev A.S., Nikolaeva G.K., Arefieva T.A., Kukushkina E.A., Zherebtsov A.I., Fedosov M.V., Zubritsky V.F., Vardanyan A.V. Venous thromboembolic complications in the wounded with combat gunshot injury in contemporary armed conflict. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (4): 40–8. DOI: https://doi.org/10.33029/1027-6661-2023-29-4-40-48