Clinical Science
Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: is it safe?

Oral presentation at the American College of Surgeons; Annual Clinical Congress, October 2013, Washington, DC, USA.
https://doi.org/10.1016/j.amjsurg.2014.03.007Get rights and content

Abstract

Background

The aim of this study was to compare the safety of early (≤48 hours), intermediate (48 to 72 hours), and late (≥72 hours) venous thromboembolism prophylaxis in patients with blunt abdominal solid organ injury managed nonoperatively.

Methods

We performed a 6-year (2006 to 2011) retrospective review of all trauma patients with blunt abdominal solid organ injuries. Patients were matched using propensity score matching in a 2:1:1 (early:intermediate:late) for age, gender, systolic blood pressure, Glasgow Coma Scale, Injury Severity Score, and type and grade of organs injured. Our primary outcome measures were: hemorrhage complications and need for intervention (operative intervention and/or angioembolization).

Results

A total of 116 patients (58 early, 29 intermediate, and 29 late) were included. There were no differences in age (P = .5), Injury Severity Score (P = .6), type (P = .1), and grade of injury of the organ (P = .6) between the 3 groups. There were 67 liver (43.2%), 63 spleen (40.6%), 49 kidney (31.6%), and 24 multiple solid organ (15.4%) injuries. There was no difference in operative intervention (P = .8) and postprophylaxis blood transfusion (P = .3) between the 3 groups.

Conclusions

Early enoxaparin-based anticoagulation may be a safe option in trauma patients with blunt solid organ injury. This study showed no significant correlation between early anticoagulation and development of bleeding complications.

Section snippets

Methods

After the approval from the Institutional Review Board of the University of Arizona, College of Medicine, we performed a 6-year (2006 to 2011) retrospective review of all trauma patients with blunt solid organ injuries who presented to our Level-1 trauma center. Patients with blunt solid organ injuries who underwent NOM and received VTE prophylaxis during their hospitalization were included. Patients transferred from other facilities and patients with isolated head injury (head Abbreviated

Results

A total of 852 patients with blunt solid organ injuries that were managed nonoperatively were reviewed. Of which, 274 patients met inclusion criteria. After matching, a total of 116 patients (58 early, 29 intermediate, and 29 late) were included in the analysis. The mean age was 42.2 ± 20.3 years, 66.4% were males, mean SBP was 130.5 ± 26.5 mm Hg, and median ISS was 17 (12 to 22). There were no differences in age (P = .5), SBP (P = .8), INR on presentation (P = .5), and injury severity (P = .6)

Comments

The fears of development of hemorrhagic complications and failure of NOM limit the early initiation of thromboembolic prophylaxis in patients with blunt solid organ injury.3, 8, 9 This study demonstrates that early enoxaparin-based anticoagulation may be safe in patients with blunt solid organ injury. In our matched cohort of patients, we found no difference in development of hemorrhagic complications and the rate of intervention between patients receiving early, intermediate, or late VTE

Conclusions

Early enoxaparin-based anticoagulation may be a safe option in trauma patients with blunt solid organ injury. This study showed no significant correlation between early anticoagulation and development of bleeding complications. Future prospective studies are required to define the impact of early VTE prophylaxis in the trauma patients.

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    In a sensitivity analysis of all studies reporting on failure of NOM (studies = 7), there remained no difference in failure of NOM between early and late initiation of chemical thromboprophylaxis (OR 1.16, 95%CI: 0.72-1.86, P = 0.54; I2 = 60%; Fig. 2C). This analysis included four studies presenting only unadjusted outcomes and three studies presenting adjusted outcomes.10,18,26 In a sensitivity analysis including all studies reporting on VTE, the association between late initiation of chemical thromboprophylaxis and VTE was attenuated and no longer statistically significant (studies = 5; OR 1.63; 95%CI: 0.97-2.73, P = 0.07; I2 = 39%; Fig. 2D).

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The authors have no financial or proprietary interest in the subject matter or materials discussed in the article.

The authors declare no conflicts of interest.

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