{
  "abstract": "Deep venous thrombosis (DVT) continues to be a major cause of morbidity and mortality in injured patients with several well-established patient-specific risk factors, including spinal cord injury, prolonged immobility, long bone fractures, older age, and dehydration. Consequently, mechanical and/or pharmacologic DVT prophylaxis is important to initiate early for patients at higher risk. However, less studied are location-specific risk factors, including environmental influences at the location of injury and at the treating hospital. Banon et al examined the effect of elevation on DVT in trauma patients at four level 1 trauma centers who treat patients at a variety of elevations. They identified a linear association between injury elevation and DVT formation, with significantly more DVTs at higher elevation, and a 0.4% rate increase per 1000 ft of elevation gained.1 On multivariable analysis, they demonstrated that high elevation of injury (defined as >5000 ft) had a nearly fourfold increased odds of developing a DVT compared with low elevation. Confounding risk factors included alcohol use disorder (2.5 OR for DVT) and low oxygen saturation (1.2 OR for DVT). Their work builds on a growing body of literature supporting that environmental factors play an important role in DVT risk stratification. Wright et al found similar results when evaluating patients in the American College of Surgeons Trauma Quality Improvement Program.2 The exact mechanism for this association is not fully elucidated, but Prabhakar and colleagues attempted to address this by examining biochemical profiles of patients in the Himalayas compared with those at sea level.3 Their findings suggest that high elevation exposure perturbs molecules that maintain vascular integrity and homeostasis, thus predisposing otherwise healthy individuals to DVT.",
  "authors": [
    {
      "affiliations": [
        "Vascular Surgery, NYU Langone Health, New York, New York, USA"
      ],
      "name": "Anastasia P Magee"
    },
    {
      "affiliations": [
        "Vascular Surgery, NYU Langone Health, New York, New York, USA"
      ],
      "name": "Gregory A Magee"
    }
  ],
  "title": "Higher calling: impact of elevation on deep venous thrombosis",
  "uid": "10bf3dfc-79d6-52c6-9494-5c15101f2a4c"
}