A meta-analysis on anticoagulation after vascular trauma

Abstract

Purpose There is much debate regarding the use of anticoagulation following vascular trauma. The aim of this meta-analysis was to compare the outcome of trauma following administration of anticoagulation medication. Methods The literature search was carried out using Ovid MEDLINE and PubMed databases to search for keywords and MeSH terms including "Anticoagulation", "Vascular Surgery", "Vascular Trauma", "Vascular Repair", "Repair" and "Wounds and Injuries". Results Use of anticoagulation was associated with a better prognosis for overall vascular trauma outcomes (weighted OR 0.46; 95% CI 0.34-0.64; P < 0.00001), as well as reduced risk of amputation for both lower and upper limb vascular trauma (weighted OR 0.42; 95% CI 0.22-0.78; P = 0.007), and reduced occurrence of reoperation events and amputations in isolated lower limb vascular trauma (weighted OR 0.27; 95% CI 0.14-0.52; P < 0.0001). Conclusion There was a statistically significant correlation between the use of anticoagulation and vascular trauma outcome. A major limitation with many of the studies includes a lack of prospective analysis and therefore we recommend prospective studies to properly elucidate prognostic outcomes following use of these anticoagulants. Further studies need to be conducted to assess the effects of timing of anticoagulant delivery, dosages and severity of traumatic injury. Thus, this would prove to be very useful in the formation of guidelines.

Emergency vascular repairs in trauma: Predictors of poor prognosis and a novel scoring system

“…The UT Houston Score may be a reasonable way to protocolize risk-stratified vascular surgery consultation. Although contraindications to systemic anticoagulation are frequent in trauma, some studies report a benefit to intraoperative and postoperative anticoagulation for arterial injuries, suggesting that systemic anticoagulation and early antiplatelet therapy may be beneficial in high-risk patients 25–28 . In the current study, postoperative medications were provider dependent and differed between trauma and vascular surgeons.…”

“…Although contraindications to systemic anticoagulation are frequent in trauma, some studies report a benefit to intraoperative and postoperative anticoagulation for arterial injuries, suggesting that systemic anticoagulation and early antiplatelet therapy may be beneficial in high-risk patients. [25][26][27][28] In the current study, postoperative medications were provider dependent and differed between trauma and vascular surgeons. Future protocolized administration of a combination of antiplatelet and anticoagulant medications may be beneficial for high-risk patients in the absence of contraindications.…”

Postoperative antiplatelet and/or anticoagulation use does not impact complication or reintervention rates after vein repair of arterial injury: A PROOVIT study

“…to the popliteal artery), but are single institutional and/or review retrospective data. A recent metanalysis that included eight such studies from 1988-2017 1,3,[20][21][22][23][24][25] examined a composite outcome for use of anticoagulants following arterial repair. This study included all anatomic locations of trauma, but did not focus on those with repair with a vein, nor did it consider postoperative AP therapy.…”

“…The optimal use of postoperative antithrombotic (AT) therapy in trauma patients presenting with arterial injury is not well-established, specifically in patients requiring reconstruction with an autologous vein graft. [1][2][3][4] While there is concern for postoperative hemorrhage in the setting of traumatic injury (at the site of vascular injury or at alternative site(s) of injury], there is also a risk of thrombosis of the vascular reconstruction. In the elective setting, patients undergoing vascular reconstruction with a vein graft are routinely treated with AT therapy; however, there is no consensus to utilize AT therapy in the trauma patient.…”

Heparin-Induced Thrombocytopenia After Revascularization of Gustilo-Anderson Type IIIC Open Lower Leg Fracture: A Case Report of Subsequent Ischemic Limb Salvage Failure

“…The treatment of this type of fracture is challenging. A meta-analysis demonstrated that the use of systemic anticoagulants in the context of vascular trauma is significantly associated with a reduction in the rates of arterial patency failure and amputation, as well as a reduced risk of VTE development [6]. Therefore, we also used heparin after vascular anastomosis in Gustilo-Anderson type IIIC open fractures; however, the patient developed HIT, which led to lower-extremity ischemia.…”