Thromboembolic Prophylaxis with Heparin in Patients with Blunt Solid Organ Injuries Undergoing Non‐operative Treatment

Khatsilouskaya, Tatsiana; Haltmeier, Tobias; Cathomas, Marionna; Eberle, Barbara M.; Candinas, Daniel; Schnüriger, Beat

doi:10.1007/s00268-016-3820-7

Cited by 22 publications

(23 citation statements)

References 38 publications

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“…25 While there has been no randomized trial comparing early and late initiation of VTE prophylaxis in SOI, there have been several observational studies comparing early (typically <48 hours after injury) with late (>48 hours after injury) initiation. [26][27][28][29][30][31][32] Uniformly in these studies, there has been no increase in postprophylaxis transfusion requirements or failure of non-operative management requiring intervention. Therefore, it appears that institution of VTE prophylaxis in patients with blunt SOI is safe and may be performed within 48 hours from the time of injury in the absence of ongoing bleeding.…”

Section: Discussionmentioning

confidence: 90%

Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Rappold

Sheppard

Carmichael

et al. 2021

Trauma Surg Acute Care Open

104

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Venous thromboembolism (VTE) is a potential sequela of injury, surgery, and critical illness. Patients in the Trauma Intensive Care Unit are at risk for this condition, prompting daily discussions during patient care rounds and routine use of mechanical and/or pharmacologic prophylaxis measures. While VTE rightfully garners much attention in clinical patient care and in the medical literature, optimal strategies for VTE prevention are still evolving. Furthermore, trauma and surgical patients often have real or perceived contraindications to prophylaxis that affect the timing of preventive measures and the consistency with which they can be applied. In this Clinical Consensus Document, the American Association for the Surgery of Trauma Critical Care Committee addresses several practical clinical questions pertaining to specific or unique aspects of VTE prophylaxis in critically ill and injured patients.

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Section: Discussionmentioning

confidence: 90%

Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Rappold

Sheppard

Carmichael

et al. 2021

Trauma Surg Acute Care Open

104

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“…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%

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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“…Bleeding and failure of NOM are among the feared complications of starting CTP in patients with SOI. Most of the current studies that assessed the safety of early vs late CTP did not find any difference between the two regarding the rates of bleeding complications or failure of NOM (16,(25)(26)(27). However, the two biggest limitation for these studies were inadequate power and the lack of a control group (i.e.…”

Section: Discussionmentioning

confidence: 82%

“…A recent study from Switzerland by Khatsilouskaya et al analyzed the safety and efficacy of CTP. In their analysis of 179 adult trauma patients with SOI with NOM, they did not find any difference between early, late or no-CTP group regarding the rate of VTE complications (16). Similarly, another study by Joseph et al analyzed 145 trauma patients with SOI who underwent NOM and received CTP with LMWH (25).…”

Section: Discussionmentioning

confidence: 93%

“…The modalities recommended for VTE prevention include mechanical prophylaxis (sequential compression devices, early ambulation), and chemical prophylaxis (unfractionated heparin or low molecular weight heparin) (13,14). The safety and efficacy of CTP in the setting of solid organ injuries are concerning for the prescribing clinician especially when considering the tradeoff between the risks of hemorrhage, failure of non-operative management (15,16), and VTE events. The timing for initiation of CTP that optimizes these risks is also poorly defined (17).…”

Section: Introductionmentioning

confidence: 99%

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Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision?

Sánchez‐Oliva

Hanna

Zeeshan

et al. 2019

J Trauma Acute Care Surg

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Thromboembolic Prophylaxis with Heparin in Patients with Blunt Solid Organ Injuries Undergoing Non‐operative Treatment

Abstract: Background: Patients with blunt solid organ injuries (SOI) are at risk for venous

Cited by 22 publications

References 38 publications

Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

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

Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision?

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