Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: is it safe?

Joseph, Bellal; Pandit, Viraj; Harrison, Caitlyn; Lubin, D; Kulvatunyou, Narong; Zangbar, Bardiya; Tang, Andrew; OʼKeeffe, Terence; Green, Donald J.; Gries, Lynn; Friese, Randall S.; Rhee, Peter

doi:10.1016/j.amjsurg.2014.03.007

Cited by 64 publications

(71 citation statements)

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“…[10][11][12] Our study adds further support for the safety of early (< 48 h) initiation of LMWH for VTE prophylaxis in patients with blunt SOIs and no significant intracranial pathology. The overall rate of failure of NOM was very low in this study, and suggests we are correctly identifying appropriate patients for a trial of NOM.…”

Section: Resultsmentioning

confidence: 86%

“…It is, however, beyond the scope of a retrospective review to determine the impact of LMWH on the amount of blood transfused, and unknown confounding factors may be present, highlighting the need for a prospective study. The lack of transfusion difference found by Joseph and colleagues 12 is perplexing as our cohorts were very similar in age, sex, ISS and grade of SOI. Therefore, it is unlikely that our study was biased toward sicker patients who may require more supportive care.…”

Section: Resultsmentioning

confidence: 91%

“…Therefore, it is unlikely that our study was biased toward sicker patients who may require more supportive care. The patients included in the study by Joseph and colleagues 12 required an average of 2 units (early group) compared with zero units in the intermediate and late groups. This difference was not significant, but the sample size was small.…”

Section: Resultsmentioning

confidence: 99%

“…Again, failure rates of 5% were reported, particularly in those patients with high grade spleen injuries; however, there was no difference between early and late groups. Joseph and colleagues 12 per formed propensity score matching on 116 patients receiv ing early, intermediate and late chemical VTE prophylaxis and who did not have significant head injuries. By match ing for confounding factors such as age, sex, systolic blood pressure, GCS score, ISS and grade of organ injury, bias was certainly limited.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of VTE was similar to that in other cohorts; however, all instances of VTE in this study were in patients receiving early rather than late chemical VTE prophylaxis. [10][11][12] Current guidelines highlight a lack of evidence for or against early initiation of chemical VTE prophylaxis in patients undergoing NOM of blunt SOIs and have in par ticular stressed the unique challenge of managing these patients. 8 A lack of evidence precluded recommendations on this specific patient population particularly regarding the timing of chemical VTE prophylaxis by the Eastern Association for the Surgery of Trauma.…”

Section: Resultsmentioning

confidence: 99%

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Very early initiation of chemical venous thromboembolism prophylaxis after blunt solid organ injury is safe

Murphy

Sothilingam

Stewart³

et al. 2016

cjs

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Very early initiation of chemical venous thromboembolism prophylaxis after blunt solid organ injury is safeBackground: The optimal timing of initiating low-molecular weight heparin (LMWH) in patients who have undergone nonoperative management (NOM) of blunt solid organ injuries (SOIs) remains controversial. We describe the safety of early initiation of chemical venous thromboembolism (VTE) prophylaxis among patients undergoing NOM of blunt SOIs. Methods:We retrospectively studied severely injured adults who sustained blunt SOI without significant intracranial hemorrhage and underwent an initial NOM at a Can adian lead trauma hospital between 2010 and 2014. Safety was assessed based on failure of NOM, defined as the need for operative intervention, in patients who received early (< 48 h) or late LMWH (≥ 48 h, or early discharge [< 72 h] without LMWH). Results:We included 162 patients in our analysis. Most were men (69%), and the aver age age was 42 ± 18 years. The median injury severity score was 17, and splenic injuries were most common (97 [60%], median grade 2), followed by liver (57 [35%], median grade 2) and kidney injuries (31 [19%], median grade 1). Combined injuries were present in 14% of patients. A total of 78 (48%) patients received early LMWH, while 84 (52%) received late LMWH. The groups differed only in percent of highgrade splenic injury (14% v. 32%). Overall 2% of patients failed NOM, none after receiving LMWH. Semielective angiography was performed in 23 (14%) patients. The overall rate of con firmed VTE on imaging was 1.9%. Conclusion:Early initiation of medical thromboembolic prophylaxis appears safe in select patients with isolated SOI following blunt trauma. A prospective multicentre study is warranted. Contexte :Le moment optimal pour commencer le traitement à l'héparine de bas poids moléculaire (HBPM) chez les patients ayant subi un traumatisme fermé à un organe plein (TFOP) avec prise en charge non chirurgicale (PCNC) demeure un sujet controversé. Nous décrivons l'innocuité d'une initiation hâtive de la chimioprophy laxie de la thromboembolie veineuse (TEV) chez les patients dont le TFOP est pris en charge de façon non chirurgicale.Méthodes : Nous avons étudié rétrospectivement les cas d'adultes gravement blessés ayant subi un TFOP sans hémorragie intracrânienne importante pris en charge de façon non chirurgicale dans un hôpital canadien de premier plan spécialisé en trauma tologie entre 2010 et 2014. L'innocuité a été évaluée en fonction du taux d'échec de la PCNC, défini comme la nécessité de recourir à une intervention chirurgicale, chez des patients qui ont reçu de l'HBPM plus tôt (< 48 h) ou plus tard (≥ 48 h, ou qui ont reçu un congé précoce [< 72 h]).

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Section: Resultsmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%