The Pathogenesis of Post-Traumatic Pulmonary Embolism: A Prospective Multi-Center Investigation by the CLOTT Study Group

Margaret Knudson, MD FACS

In order to address the dearth of knowledge in the area of VTE prevention after injury, a number of experts in the field came together to form the Consortium of Leaders in the study Of Traumatic Thromboembolism (CLOTT). In its first study, the CLOTT study group developed and published a position paper documenting the current variability in the prevention and management of venous thromboembolic disease following trauma, even among those considered experts in the field. Each of the 17 trauma surgeon members of CLOTT (representing 17 separate major trauma centers) were queried about their institutional practice and asked to complete a survey consisting of 18 questions focused on five general post-traumatic VTE topics: DVT surveillance, pharmacologic prophylaxis, treatment of diagnosed VTE, use of VCF, and tests for hyper/hypo-coagulability. The results of this survey were astounding, illustrating that practice patterns are quite variable. This was especially true with the use of prophylactic VCF in patients considered at high-risk for VTE but who had contraindications to pharmacologic prophylaxis. Perhaps most relevant to the current study, there was no consensus as to the need to treat asymptomatic pulmonary thrombi found in the periphery of the lung discovered incidentally on chest computed tomography (CTA).

CLOTT investigators have also designed a database and an accompanying data dictionary to be utilized to collect data for all CLOTT studies going forward. These data elements are specific for VTE risk assessment and prophylactic measures utilized in patients admitted after trauma. The CLOTT database is housed in the electronic data collection tool called REDCap (Research Electronic Data Capture).