Clinical Science
The safety of low molecular-weight heparin after blunt liver and spleen injuries

Presented by Dr Rostas at the AAST conference in 2012 at Kauai, Hawaii.
https://doi.org/10.1016/j.amjsurg.2014.08.023Get rights and content

Abstract

Background

Anticoagulation is routinely administered to all trauma patients owing to the high incidence of venous thromboembolism (VTE). However, the timing of administration of anticoagulation is not clearly defined when patients have blunt spleen or liver injuries because of the perceived risk of hemorrhage with early administration.

Methods

A retrospective chart review was performed of all blunt trauma patients who sustained blunt liver and/or spleen injuries during the 5-year period from 2007 to 2011. Data were collected for all patients managed with nonoperative therapy for these injuries while also receiving routine prophylactic anticoagulation with low molecular-weight heparin. Patients were categorized based on the initiation of enoxaparin therapy after injury: early (<48 hours), intermediate (48 to 72 hours), and late (>72 hours). Primary and secondary outcomes were designated as need for operative or radiologic intervention secondary to spleen or liver hemorrhage, number of transfusions, and incidence of VTE.

Results

Three hundred and twenty-eight patients were included. There were no enoxaparin-related hemorrhagic complications or hemorrhage necessitating operative intervention. Patients in the early, intermediate, and late groups received an average of .9, .93, and 1.55 units of blood, respectively. There was 1 pulmonary embolism in the early group, and there were 6 VTE complications in the late group (3 deep venous thromboses and 3 pulmonary embolisms).

Conclusions

There are currently no standards for the initiation of prophylactic anticoagulation in trauma patients with blunt liver and spleen injuries. Early administration may be safe and reduce the incidence of thrombotic complications in patients with blunt spleen and liver injuries. Prospective studies in this area are warranted.

Section snippets

Methods

After institutional review board approval, a retrospective review of all blunt liver and spleen injuries was performed at 2 academic level 1 trauma centers, the University of South Alabama and the University of Mississippi Medical Center. Data were collected for all blunt trauma patients admitted during years 2007 through 2011 who underwent NOM of liver and/or splenic injuries. All patients received routine prophylactic anticoagulation with LMWH (enoxaparin). Collected data included date and

Results

Three hundred fifty-five patients with blunt spleen or liver injuries were identified from the study period, 172 from the University of South Alabama and 183 from the University of Mississippi. Three hundred twenty-eight of these patients had complete information concerning LMWH administration. One hundred three patients (31%) received LMWH early, 54 (17%) in the intermediate group, and 171 patients (52%) were in the late administration group (Table 1, Table 2). All patients had an initial

Comment

In this retrospective study investigating the safety of administration of LMWH in patients with solid organ injury, there were no failures of NOM in patients who received LMWH in any group. Also, there was no difference in the amount of blood products administered or bleeding complications from any group. VTE complications were higher in the patients that received LMWH more than 72 hours after hospital admission, suggesting that early chemical VTE prophylaxis may be beneficial in trauma

Conclusion

Early use of prophylactic LMWH does not appear to increase NOM failure rates or blood transfusion requirements in this cohort. Therefore, early administration of LMWH may decrease the incidence of VTE in patients with blunt solid organ injury without incurring the risk of hemorrhagic complications. Further prospective investigation is warranted to confirm the safety and optimal timing of early prophylactic LMWH administration in patients with high-grade blunt solid organ injuries.

Acknowledgments

Jon Simmons is the principal investigator and contributed toward study design, data collection, and manuscript development. Justin Manley contributed toward study design, data collection, and manuscript revisions. Jack Rostas contributed toward statistical analysis, data collection, and manuscript development. Richard Gonzalez contributed toward manuscript development and revisions. Sidney Brevard contributed toward manuscript revisions. Naveed Ahmed contributed toward study design, and

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All authors participated in the analysis and interpretation of data.

Dr Simmons is supported by the American College Surgeons Clowes Award and the American Heart Association (14CRP19010032). The other authors declare no conflicts of interest.

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