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:

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* 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?

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* 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?

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* 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?

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* 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?

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* 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)

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* 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)

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* 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?

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* 8. Is there anything else related to this topic you want us to know or consider when planning a research study?

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