Early Venous Thromboembolism Prophylaxis for Isolated High-Grade Blunt Splenic Injury

Lin, Brenda; Matsushima, Kazuhide; León, Luis de; Piccinini, Alice; Recinos, Gustavo; Love, Bryan; Inaba, Kenji; Δημητριάδης, Δημήτριος

doi:10.1016/j.jss.2019.05.060

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…All studies were retrospective with the exception of one [3] and all were within the last 20 years. Two studies used the ACS-TQIP dataset for the years 2013-2014, [9,12] with Skarupa et al examining all blunt solid organ injury within this time period and Lin et al…”

Section: Resultsmentioning

confidence: 99%

“…Recently, the optimal time to initiate VTE chemoprophylaxis after blunt solid organ injury has been an area of active research focus. A number of prospective [3] and retrospective [4][5][6][7][8][9][10][11][12] studies have demonstrated that VTE chemoprophylaxis administration 24-48 hours after arrival to the Emergency Department (ED) is associated with reduced rates of VTE without increased need for blood transfusion or failure of nonoperative management. On this basis, we hypothesize that VTE chemoprophylaxis initiated ≤48 hours of ED arrival is safe and effective at preventing VTEs without an associated increased need for blood transfusion.…”

Section: Introductionmentioning

confidence: 99%

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Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review

Murphy

Moya

Karam

et al. 2021

Eur J Trauma Emerg Surg

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The need to prevent venous thromboembolism (VTE) following blunt solid organ injury must be balanced against the concern for exacerbation of hemorrhage. The optimal timing for initiation of VTE chemoprophylaxis is not known. The objective was to determine the safety and efficacy of early (≤48 hours) VTE chemoprophylaxis initiation following blunt solid organ injury.METHODS: An electronic search was performed of medical libraries for English-language studies on timing of VTE chemoprophylaxis initiation following blunt solid organ injury published from inception to April 2020. Included studies compared early (≤48 hours) versus late (>48 hours) initiation of VTE chemoprophylaxis in adults with blunt splenic, liver and/or kidney injury.Estimates were pooled using random-effects meta-analysis. Odds ratios were utilized to quantify differences in failure of nonoperative management, need for blood transfusion and rates of VTE. RESULTS:The search identified 2,111 studies. Of these, ten studies comprising 14,675 patients were included. All studies were non-randomized and only one was prospective. The overall odds of failure of nonoperative management were no different between early and late groups, OR 1.09 (95%CI 0.92-1.29). Similarly, there was no difference in the need for blood transfusion either during overall hospital stay, OR 0.91 (95%CI 0.70-1.18), or post prophylaxis initiation, OR 1.23 (95%CI 0.55-2.73). There were significantly lower odds of VTE when patients received early VTE chemoprophylaxis, OR 0.51 (95%CI 0.33-0.81). CONCLUSIONS: Patients undergoing nonoperative management for blunt solid organ injury can be safely and effectively prescribed early VTE chemoprophylaxis. This results in significantly lower VTE rates without demonstrable harm.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review

Murphy

Moya

Karam

et al. 2021

Eur J Trauma Emerg Surg

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“…Moreover, in the linear regression analysis model describing the time to initiation of DVT prophylaxis using age, sex, splenic injury grade, and ISS, the NOM failure rate decreased by 0.00002% for each hour prior to giving DVT prophylaxis ( P = 0.111). From this, the authors proposed a non- inferiority statement that initiating DVT prophylaxis within 48 h does not increase the failure rate compared to patients receiving DVT prophylaxis between 48 and 72 h. The results reported by Kwok et al [ 43 ] corroborated the statement that early initiation within < 48 h of VTE prophylaxis is safe in patients with blunt splenic injuries treated non-operatively, but also it may be safe as early as 24 h. Lin et al [ 46 ] explored the American College of Surgeons TQIP database from 2013 to 2014 to identify adult patients who underwent NOM for isolated AAST Grade III–V blunt splenic injuries. The incidence of NOM failure after the initiation of VTE prophylaxis was compared between two groups: VTE prophylaxis ≤ 48 h after admission (early prophylaxis group) and > 48 h (late prophylaxis group).…”

Section: Methodsmentioning

confidence: 91%

“…The 2017 WSES guidelines stated that LMWH-based prophylactic anticoagulation should be started as soon as possible from splenic trauma, including patients treated with NOM [1]. Our systematic review of the literature regarding this topic retrieved 15 studies, of which two were systematic reviews and meta-analyses [40,41], two were prospective cohort studies [35,38], and 11 were retrospective cohort studies [27,28,36,37,[42][43][44][45][46][47][48]. To date, two systematic reviews and meta-analyses demonstrated that patients undergoing NOM for blunt solid organ injury could be safely and effectively prescribed early VTE prophylaxis.…”

Section: Priority Level: Highmentioning

confidence: 99%

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Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

et al. 2022

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Background In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. Methods Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM. Results Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I–II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II–III, AAST Grades III–V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries—WSES Class I, AAST Grades I–II) to 3 days (for high-grade splenic injuries—WSES Classes II–III, AAST Grades III–V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48–72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV–V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48–72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications. Conclusion This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.

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Thromboprophylaxis Timing After Blunt Solid Organ Injury: A Systematic Review and Meta-analysis

Anteby

Allar²,

Broekhuis³

et al. 2023

Journal of Surgical Research

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Early Venous Thromboembolism Prophylaxis for Isolated High-Grade Blunt Splenic Injury

Cited by 7 publications

References 19 publications

Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review

Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

Thromboprophylaxis Timing After Blunt Solid Organ Injury: A Systematic Review and Meta-analysis

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