CASTING
Trial question
What is the role of targeted prophylactic anticoagulation based on the TRiP(cast) score in patients with lower limb immobilization?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
48.0% female
52.0% male
N = 2108
2108 patients (1005 female, 1103 male).
Inclusion criteria: adult patients presenting to the emergency department with lower limb trauma requiring immobilization for at least 7 days.
Key exclusion criteria: anticoagulant treatment at the time of trauma; trauma requiring hospitalization of > 48 hours; comorbidity requiring hospitalization of > 48 hours at the time of inclusion; any factor making 90-day follow-up impossible; pregnancy; psychiatric care under duress.
Interventions
N=1505 targeted prophylactic anticoagulation (withholding prophylactic anticoagulation with a TRiP(cast) score is < 7 and initiation of anticoagulation with a TRiP (cast)score ≥ 7).
N=603 standard care (autonomous decision of the physician to prescribe or not to prescribe an anticoagulant depending on the local practice).
Primary outcome
Venous thromboembolism at 3 months in low-risk patients
0.7%
0.4%
0.7 %
0.5 %
0.3 %
0.2 %
0.0 %
Targeted prophylactic
anticoagulation
Standard
care
No significant
difference ↔
No significant difference in VTE at 3 months in low-risk patients (0.7% vs. 0.4%; AD 0.3%, 95% CI -0.2 to 0.5).
Secondary outcomes
No significant difference in VTE at 3 months in high-risk patients (2.6% vs. 2.8%; ARD -0.2, 95% CI -0.3 to 0.3).
Significant decrease in anticoagulant prescription rate (24.5% vs. 50.4%; ARD -26, 95% CI -30.2 to -21.7).
Conclusion
In adult patients presenting to the emergency department with lower limb trauma requiring immobilization for at least 7 days, targeted prophylactic anticoagulation was not superior to standard care with respect to VTE at 3 months in low-risk patients.
Reference
Delphine Douillet, Andrea Penaloza, Damien Viglino et al. Targeted prophylactic anticoagulation based on the TRiP(cast) score in patients with lower limb immobilisation: a multicentre, stepped wedge, randomised implementation trial. Lancet. 2024 Mar 16;403(10431):1051-1060.
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