Routine Pharmacological Venous Thromboembolism (VTE) Prophylaxis in Lower-Limb Injuries: A Three-Year Retrospective Cross-Sectional Study and Service Evaluation.

Background Lower-limb injury and immobilisation substantially increase the risk of venous thromboembolism (VTE). This study assessed outcomes following the introduction of routine pharmacological VTE prophylaxis for patients with lower-limb injuries at a UK teaching hospital. Aim The aim of the study is to evaluate three years of routine VTE prophylaxis in lower-limb injuries, focusing on inpatient thromboembolic events, bleeding outcomes, and prescribing patterns. Methods This retrospective study reviewed consecutive patients with lower-limb injuries managed in a single UK teaching trust following the introduction of routine pharmacological VTE prophylaxis. Data were extracted from the hospital's Prescribing Information and Communication System (PICS) covering the period 2022-2024. Data represented all lower-limb injury admissions over a three-year period rather than longitudinal follow-up of individual patients. The primary outcomes were symptomatic VTE events (deep vein thrombosis (DVT) or pulmonary embolism (PE)) during hospitalisation, recorded bleeding episodes during hospitalisation, and prescribing patterns of prophylaxis agents. Results A total of 4,011 patients were included (mean age 53.4 ± 21.1 years, and 54.6% were women). Enoxaparin was the predominant prophylactic agent (86.5%), followed by apixaban (5.9%). Bleeding-related entries were identified in 36.0% of patients. No DVT cases were identified, and one PE was recorded during the three-year study period. Conclusion Routine VTE prophylaxis, predominantly low-molecular-weight heparin (LMWH)-based with limited direct oral anticoagulant (DOAC) use, appears effective in substantially reducing thromboembolic events in lower-limb injuries, though inpatient bleeding entries were common but ungraded.