Is Early Chemical Thromboprophylaxis in Patients with Solid Organ Injury a Solid Decision?
Skarupa, David MD1; Hanna, Kamil MD2; Zeeshan, Muhammad MD2; Madbak, Firas MD1; Hamidi, Mohammad MD2; Haddadin, Zaid MD2; Northcutt, Ashley MD2; Gries, Lynn MD2; Kulvatunyou, Narong MD2; Joseph, Bellal MD2

Journal of Trauma and Acute Care Surgery: July 9, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/TA.0000000000002438
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Background The optimal time to initiate chemical thromboprophylaxis (CTP) in patients who have undergone non-operative management (NOM) of blunt solid organ injuries remains controversial. The aim of our study was to assess the impact of early initiation of CTP in patients with blunt abdominal solid organ injuries (SOI).

Methods We performed a 2-year (2013-14) retrospective analysis of ACS-TQIP. We included all adult trauma patients (Age≥18 years) with blunt SOI who underwent NOM. Patients were stratified into 3 groups based on timing of CTP (early≤48-hours of injury, late>48-hours of injury and No Prophylaxis group). Our primary outcomes were rates of failure of NOM, pRBC transfusion, and mortality. Our secondary outcomes were the rate of venous thromboembolic (VTE) events (i.e. DVT and/or PE), and length of stay.

Results A total of 36,187 patients met the inclusion criteria. Mean age was 49.5±19y and 36% of patients received CTP (Early: 37% (n=4,819) vs. Late: 63% (n=8,208)). After controlling for confounders, patients receiving early CTP had lower rates of DVT (p=0.01) and PE (p=0.01) compared to the no prophylaxis and late CTP groups. There was no difference between the three groups regarding the post-prophylaxis pRBCs transfusions, failure of NOM, and mortality.

Conclusions Our results suggest that in patients undergoing NOM of blunt abdominal SOI, early initiation of CTP should be considered. It is associated with decreased rates of DVT and PE, with no significant difference in post prophylaxis pRBCs transfusion, failure of non-op management, and mortality.

Level of Evidence Level IV Therapeutic

© 2019 Lippincott Williams & Wilkins, Inc.