Language:

When is it safe to start venous thromboembolism prophylaxis after blunt solid organ injury? A prospective American Association for the Surgery of Trauma multi-institutional trial

Schellenberg, Morgan ; Owattanapanich, Natthida ; Emigh, Brent ; Van Gent, Jan-Michael ; Egodage, Tanya ; Murphy, Patrick B ; Ball, Chad G ; Spencer, Audrey L ; Vogt, Kelly N ; Keeley, Jessica A ; Doris, Stephanie ; Beiling, Marissa ; Donnelly, Megan ; Ghneim, Mira ; Schroeppel, Thomas ; Bradford, James ; Breinholt, Connor S ; Coimbra, Raul ; Berndtson, Allison E ; Anding, Catherine ; Charles, Michael S ; Rieger, William ; Inaba, Kenji

The journal of trauma and acute care surgery, 2024-02, Vol.96 (2), p.209-215 [Peer Reviewed Journal]

United States

Full text available

Citations Cited by

Actions
1. Add to e-Shelf
2. Remove from e-Shelf
3. E-mail
4. Print
5. Permalink
6. Citation
7. EasyBib
8. EndNote
9. RefWorks
10. Delicious
11. Export RIS
12. Export BibTeX

Title:
When is it safe to start venous thromboembolism prophylaxis after blunt solid organ injury? A prospective American Association for the Surgery of Trauma multi-institutional trial
Author: Schellenberg, Morgan ; Owattanapanich, Natthida ; Emigh, Brent ; Van Gent, Jan-Michael ; Egodage, Tanya ; Murphy, Patrick B ; Ball, Chad G ; Spencer, Audrey L ; Vogt, Kelly N ; Keeley, Jessica A ; Doris, Stephanie ; Beiling, Marissa ; Donnelly, Megan ; Ghneim, Mira ; Schroeppel, Thomas ; Bradford, James ; Breinholt, Connor S ; Coimbra, Raul ; Berndtson, Allison E ; Anding, Catherine ; Charles, Michael S ; Rieger, William ; Inaba, Kenji
Subjects: Adult ; Anticoagulants - therapeutic use ; Female ; Hemorrhage - drug therapy ; Humans ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies ; United States ; Venous Thromboembolism - etiology ; Venous Thromboembolism - prevention & control ; Wounds, Nonpenetrating - complications ; Wounds, Nonpenetrating - drug therapy ; Wounds, Nonpenetrating - surgery
Is Part Of: The journal of trauma and acute care surgery, 2024-02, Vol.96 (2), p.209-215
Notes: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
content type line 23
Description: The optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis (VTEp) after blunt solid organ injury remains controversial, as VTE mitigation must be balanced against bleeding promulgation. Evidence from primarily small, retrospective, single-center work suggests that VTEp ≤48 hours is safe and effective. This study was undertaken to validate this clinical practice. Blunt trauma patients presenting to 19 participating trauma centers in North America were screened over a 1-year study period beginning between August 1 and October 1, 2021. Inclusions were age older than 15 years; ≥1 liver, spleen, or kidney injury; and initial nonoperative management. Exclusions were transfers, emergency department death, pregnancy, and concomitant bleeding disorder/anticoagulation/antiplatelet medication. A priori power calculation stipulated the need for 1,158 patients. Time of VTEp initiation defined study groups: Early (≤48 hours of admission) versus Late (>48 hours). Bivariate and multivariable analyses compared outcomes. In total, 1,173 patients satisfied the study criteria with 571 liver (49%), 557 spleen (47%), and 277 kidney injuries (24%). The median patient age was 34 years (interquartile range, 25-49 years), and 67% (n = 780) were male. The median Injury Severity Score was 22 (interquartile range, 14-29) with Abbreviated Injury Scale Abdomen score of 3 (interquartile range, 2-3), and the median American Association for the Surgery of Trauma grade of solid organ injury was 2 (interquartile range, 2-3). Early VTEp patients (n = 838 [74%]) had significantly lower rates of VTE (n = 28 [3%] vs. n = 21 [7%], p = 0.008), comparable rates of nonoperative management failure (n = 21 [3%] vs. n = 12 [4%], p = 0.228), and lower rates of post-VTEp blood transfusion (n = 145 [17%] vs. n = 71 [23%], p = 0.024) when compared with Late VTEp patients (n = 301 [26%]). Late VTEp was independently associated with VTE (odd ratio, 2.251; p = 0.046). Early initiation of VTEp was associated with significantly reduced rates of VTE with no increase in bleeding complications. Venous thromboembolism chemoprophylaxis initiation ≤48 hours is therefore safe and effective and should be the standard of care for patients with blunt solid organ injury. Therapeutic and Care Management; Level III.
Publisher: United States
Language: English

Links

View this record in MEDLINE/PubMed

Back to results list

Implemented by: Social Network Logos:

When is it safe to start venous thromboembolism prophylaxis after blunt solid organ injury? A prospective American Association for the Surgery of Trauma multi-institutional trial

United States

Searching Remote Databases, Please Wait