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Do you treat pulmonary thrombosis (in-situ) different than pulmonary embolism (from DVT) in injured patients?

Survey Introduction

· Traditionally, all pulmonary clots after trauma were believed to be embolic, arising from deep vein thrombosis, and accordingly have been treated by some clinicians as pulmonary embolism (PE) with therapeutic-dose anticoagulation.

· More recently, studies support that the pathogenesis of certain pulmonary clots in injured patients are not embolic, but rather due to de novo thrombosis in the pulmonary circulation. These post-traumatic pulmonary thrombosis (PT) are believed to differ in etiology from PE, and may not require therapeutic-dose anticoagulation, which could reduce the risk of bleeding and improve the quality of life for patients during recovery from injury.

· The best clinical approach in the management of PT after injury is not currently known.

· We seek to understand current practice patterns for PT in order to help guide the design of a clinical trial to study anticoagulation in this condition.

Please answer seven multiple-choice questions about how you manage PT:
1.A 40-year-old woman presents as a highest level trauma activation with blunt thoracic injury but no signs of active bleeding in the chest or other anatomic regions. She has a segmental PT diagnosed on her admission CT scans. A duplex ultrasound exam of both lower extremities reveals no evidence of DVT. What would be your approach to manage her PT?
2.A 40-year-old woman presents as a level 1 trauma with blunt thoracic injury but no signs of active bleeding in the chest or other anatomic regions. She has a subsegmental PT diagnosed on her admission CT scans. A duplex ultrasound exam of both lower extremities reveals no evidence of DVT. What would be your approach to manage her PT?
3.A 40-year-old woman presents as a highest level trauma activation with blunt thoracic injury, pelvic fracture and femur fracture. She has a segmental PT diagnosed on her admission CT scans. A duplex ultrasound exam of both lower extremities reveals no evidence of DVT. What would be your approach to manage her PT?
4.A 40-year-old woman presents as a highest level trauma activation with blunt thoracic injury, pelvic fracture and femur fracture. She has a subsegmental PT diagnosed on her admission CT scans. A duplex ultrasound exam of both lower extremities reveals no evidence of DVT. What would be your approach to manage her PT?
5.Signs or symptoms that would factor in your decision making regarding therapeutic-dose versus prophylactic-dose anticoagulation for a patient with segmental PT include: (select all that apply)
6.Signs or symptoms that would factor in your decision making regarding therapeutic-dose versus prophylactic-dose anticoagulation for a patient with subsegmental PT include: (select all that apply)
7.Would you be willing to randomize patients with PT to either prophylactic dose or therapeutic dose anticoagulation in a clinical trial to study anticoagulation in this condition?
8.Is there anything else related to this topic you want us to know or consider when planning a research study?