Early Venous Thromboembolism Prophylaxis for Isolated High-Grade Blunt Splenic Injury.
High-grade blunt splenic injury
Nonoperative management
Safety
Venous thromboembolism prophylaxis
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
11
02
2019
revised:
23
04
2019
accepted:
30
05
2019
pubmed:
6
7
2019
medline:
1
2
2020
entrez:
6
7
2019
Statut:
ppublish
Résumé
Nonoperative management (NOM) has become more common in hemodynamically stable patients with high-grade blunt splenic injury. However, there are no widely accepted guidelines for an optimal and safe timeframe for the initiation of venous thromboembolism (VTE) prophylaxis. The purpose of this study was to explore the association between the timing of VTE prophylaxis initiation and NOM failure rate in isolated high-grade blunt splenic injury. We utilized the American College of Surgeons Trauma Quality Improvement Program database (2013-2014) to identify adult patients who underwent NOM for isolated high-grade blunt splenic injuries (grades 3-5). 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). A total of 816 patients met the inclusion criteria. Of those, VTE prophylaxis was not administered in 525 patients (64.3%), whereas VTE prophylaxis was given <48 h and ≥48 h after admission in 144 and 147 patients, respectively. There was no significant difference in the NOM failure rate after the initiation of VTE prophylaxis between the early and late prophylaxis groups (3.5% versus 3.4%, P = 1.00). In the multiple logistic regression analysis, early initiation of VTE prophylaxis was not significantly associated with NOM failure (OR: 1.32, 95% CI 0.35-4.93, P = 0.68). The results of our study suggest that early initiation of VTE prophylaxis (<48 h) does not increase the risk of NOM failure in patients with isolated high-grade blunt splenic injury.
Sections du résumé
BACKGROUND
Nonoperative management (NOM) has become more common in hemodynamically stable patients with high-grade blunt splenic injury. However, there are no widely accepted guidelines for an optimal and safe timeframe for the initiation of venous thromboembolism (VTE) prophylaxis. The purpose of this study was to explore the association between the timing of VTE prophylaxis initiation and NOM failure rate in isolated high-grade blunt splenic injury.
METHODS
We utilized the American College of Surgeons Trauma Quality Improvement Program database (2013-2014) to identify adult patients who underwent NOM for isolated high-grade blunt splenic injuries (grades 3-5). 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).
RESULTS
A total of 816 patients met the inclusion criteria. Of those, VTE prophylaxis was not administered in 525 patients (64.3%), whereas VTE prophylaxis was given <48 h and ≥48 h after admission in 144 and 147 patients, respectively. There was no significant difference in the NOM failure rate after the initiation of VTE prophylaxis between the early and late prophylaxis groups (3.5% versus 3.4%, P = 1.00). In the multiple logistic regression analysis, early initiation of VTE prophylaxis was not significantly associated with NOM failure (OR: 1.32, 95% CI 0.35-4.93, P = 0.68).
CONCLUSIONS
The results of our study suggest that early initiation of VTE prophylaxis (<48 h) does not increase the risk of NOM failure in patients with isolated high-grade blunt splenic injury.
Identifiants
pubmed: 31277010
pii: S0022-4804(19)30389-0
doi: 10.1016/j.jss.2019.05.060
pii:
doi:
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
340-345Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.