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Clinical Trial
. 2024 Feb 1;96(2):209-215.
doi: 10.1097/TA.0000000000004163. Epub 2023 Oct 24.

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

Morgan Schellenberg  1 , Natthida Owattanapanich, Brent Emigh, Jan-Michael Van Gent, Tanya Egodage, Patrick B Murphy, Chad G Ball, Audrey L Spencer, Kelly N Vogt, Jessica A Keeley, Stephanie Doris, Marissa Beiling, Megan Donnelly, Mira Ghneim, Thomas Schroeppel, James Bradford, Connor S Breinholt, Raul Coimbra, Allison E Berndtson, Catherine Anding, Michael S Charles, William Rieger, Kenji Inaba; AAST VTE Prophylaxis Study Group
Collaborators, Affiliations
Clinical Trial

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

Morgan Schellenberg et al. J Trauma Acute Care Surg. .

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Level of evidence: Therapeutic and Care Management; Level III.

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References

    1. Nathens AB, McMurray MK, Cuschieri J, Durr EA, Moore EE, Bankey PE, et al. The practice of venous thromboembolism prophylaxis in the major trauma patient. J Trauma . 2007;62(3):557–562.
    1. Van Haren RM, Valle EJ, Thorson CM, Jouria JM, Busko AM, Guarch GA, et al. Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism. J Trauma Acute Care Surg . 2014;76(2):443–449.
    1. Knudson MM, Moore HB, Moore EE, Kornblith LZ, Kiraly LN, McNutt MK, et al. Tissue plasminogen activator resistance is an early predictor of posttraumatic venous thromboembolism: a prospective study from the CLOTT research group. J Trauma Acute Care Surg . 2022;93(5):597–603.
    1. Park MS, Perkins SE, Spears GM, Ashrani AA, Leibson CL, Boos CM, et al. Risk factors for venous thromboembolism after acute trauma: a population-based case-cohort study. Thromb Res . 2016;144:40–45.
    1. Ley EJ, Brown CVR, Moore EE, Sava JA, Peck K, Ciesla DJ, et al. Updated guidelines to reduce venous thromboembolism in trauma patients: a Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg . 2020;89(5):971–981.

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