Jan. 27, 2026
The very nature of traumatic injury can lead to venous thromboembolism (VTE), according to Alec J. Williams, APRN, C.N.P., D.N.P., a nurse practitioner in trauma and emergency general surgery at Mayo Clinic in Rochester, Minnesota.
"Any trauma patient is at risk for VTE, but risk can vary based on the mechanism of injury," he says. "The injury itself kicks off hypercoagulability. We then make the patient immobile in the hospital, adding to VTE risk."
Daniel F. Labuz, M.D., a pediatric general surgeon at Mayo Clinic in Rochester, Minnesota, who has researched VTE in the pediatric population in which this condition is rarer, agrees that trauma multiplies the potential for VTE.
"Trauma produces a stress response, plus the patient has also experienced trauma to a specific anatomic region," says Dr. Labuz. "This puts the patient's body in a prothrombotic state, locally and systemically."
Dr. Williams cites Virchow triad, in which there are three main components of venous thrombosis: hypercoagulability, venous stasis and endothelial injury.
Some types of traumas promote an increased hemorrhage risk in which the patient often is actively bleeding upon entering the medical center, corresponding to a higher VTE risk.
- Intracranial injury, such as traumatic brain injury.
- Pelvic or lower extremity injury.
- Spinal fracture or spinal cord injury.
- Solid organ injury.
In addition to the type of injury, the severity of injury significantly influences VTE risk, with higher injury severity scores associated with a greater likelihood of developing VTE, says Dr. Labuz.
He says that VTE prophylactic measures in the U.S. have lowered VTE rates from 10% to 15% to approximately 8%. Yet, he would like to see more improvements.
"The VTE rate has definitely lowered, but it's not gone — it's not zero," he says.
VTE and trauma practice
Dr. Williams says that increasing knowledge about the connection between traumatic injury and VTE has impacted the practice at Mayo Clinic trauma centers. Now, anytime one trauma professional hands off a patient to another professional, they must discuss VTE risk and the patient's VTE prevention plan, and even reassess the risk, as appropriate. The prophylaxis plan invariably involves chemoprophylaxis, though trauma professionals must be aware of the indications where this type of VTE prevention requires additional consideration, such as those with a known heparin allergy or a severe kidney condition.
"One challenge to identify VTE is that patients can be asymptomatic, though problems may arise later," says Dr. Labuz.
"Several inherent features of trauma practice make tracking and addressing a patient's VTE risk status more challenging while professionals are working to rapidly identify injuries and coordinate with multiple medical and surgical services," says Dr. Williams. "The patient is present with the trauma professionals under abnormal, unforeseen and nonelective circumstances. These practice features make coordinated communication and clear management strategies critical to monitor and address VTE in trauma patients."
According to Dr. Labuz, though VTE screening remains controversial, trauma professionals can be alert to potential signs of VTE particularly through noting any signs of swelling or complaints of calf pain in their patients.
Impact of well-timed VTE prophylaxis
Dr. Williams notes that precise timing cannot be emphasized enough to prevent VTE in trauma patients. He suggests VTE risk stratification for all trauma patients and starting chemoprophylaxis within 24 hours unless contraindicated.
In addition to initiating chemoprophylaxis, mechanical VTE prophylaxis also must be performed on trauma patients following risk assessment. Dr. Williams notes that it is crucial to have both chemoprophylaxis and mechanical prophylaxis working in tandem to decrease VTE risk, and that use of just one or the other strategy is less effective. Yet, he also emphasizes the use of common sense in administering VTE prophylaxis.
"We also must be mindful of the location of the injury," says Dr. Williams. "We would not want to put a patient with a lower extremity injury in leg squeezers."
For patients who may require extended VTE prophylaxis after discharge, trauma professionals may involve orthopedic surgical teams that can assess long-term risk associated with specific injury patterns and guide continued prevention strategies.