Early pharmacologic thromboprophylaxis after splenectomy is associated with better outcomes: A matched cohort study.

Adult Anticoagulants / therapeutic use Cohort Studies Heparin, Low-Molecular-Weight / therapeutic use Humans Retrospective Studies Splenectomy / adverse effects Venous Thromboembolism / etiology

Journal

American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473

Informations de publication

Date de publication:
07 2022
Historique:
received: 29 10 2021
revised: 20 01 2022
accepted: 30 01 2022
pubmed: 14 2 2022
medline: 28 6 2022
entrez: 13 2 2022
Statut: ppublish

Résumé

This study aimed to explore the timing of pharmacologic prophylaxis initiation after trauma splenectomy and the development of venous thromboembolism (VTE). Retrospective review of American College of Surgeons Trauma Quality Improvement Program (TQIP) database 2013-2017. Adults (>16 years) with isolated splenic injuries who underwent splenectomy and received pharmacologic VTE prophylaxis were stratified based on timing of initiation of prophylaxis: ≤48 h (EARLY) or > 48 h (LATE) from admission. Patients were matched for demographic and clinical characteristics and outcomes compared. 3631 patients were included. On logistic regression, LATE prophylaxis was associated with DVT (OR 2.317, p < 0.001) and VTE (OR 2.064, p < 0.001). Low molecular weight heparin (LMWH) was protective for DVT (OR 0.621, p = 0.014) and VTE (OR 0.667, p = 0.015). 1196 patients with EARLY prophylaxis were matched with 1196 patients with LATE prophylaxis. VTE and overall complications were significantly higher in the LATE group (7.4% vs. 4.3%, p = 0.001 and 25.8% vs 16.6%, p < 0.001). Late initiation of VTE prophylaxis is associated with DVT and VTE in post-splenectomy patients, while LMWH is protective.

Sections du résumé

BACKGROUND
This study aimed to explore the timing of pharmacologic prophylaxis initiation after trauma splenectomy and the development of venous thromboembolism (VTE).
METHODS
Retrospective review of American College of Surgeons Trauma Quality Improvement Program (TQIP) database 2013-2017. Adults (>16 years) with isolated splenic injuries who underwent splenectomy and received pharmacologic VTE prophylaxis were stratified based on timing of initiation of prophylaxis: ≤48 h (EARLY) or > 48 h (LATE) from admission. Patients were matched for demographic and clinical characteristics and outcomes compared.
RESULTS
3631 patients were included. On logistic regression, LATE prophylaxis was associated with DVT (OR 2.317, p < 0.001) and VTE (OR 2.064, p < 0.001). Low molecular weight heparin (LMWH) was protective for DVT (OR 0.621, p = 0.014) and VTE (OR 0.667, p = 0.015). 1196 patients with EARLY prophylaxis were matched with 1196 patients with LATE prophylaxis. VTE and overall complications were significantly higher in the LATE group (7.4% vs. 4.3%, p = 0.001 and 25.8% vs 16.6%, p < 0.001).
CONCLUSIONS
Late initiation of VTE prophylaxis is associated with DVT and VTE in post-splenectomy patients, while LMWH is protective.

Identifiants

DOI: 10.1016/j.amjsurg.2022.01.030 PMID: 35151431
pubmed: 35151431
pii: S0002-9610(22)00054-X
doi: 10.1016/j.amjsurg.2022.01.030
pii:
doi:

Substances chimiques

Anticoagulants 0
Heparin, Low-Molecular-Weight 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

535-538

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

Auteurs

Delbrynth P Mitchao (DP)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: delbrynth.mitchao@icloud.com.

Meghan R Lewis (MR)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: meghan.lewis@med.usc.edu.

Elizabeth R Benjamin (ER)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: Elizabeth.robinson.benjamin@emory.edu.

Dominik A Jakob (DA)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: d.jakob@swissonline.ch.

Demetrios Demetriades (D)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: demetrios.demetriades@med.usc.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Early pharmacologic thromboprophylaxis after...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Early pharmacologic thromboprophylaxis after...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Early pharmacologic thromboprophylaxis after...
questionsmedicales.fr › Glucides › Polyosides › Glycosaminoglycanes › Héparine › Héparine bas poids moléculaire › Early pharmacologic thromboprophylaxis after...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Early pharmacologic thromboprophylaxis after...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Early pharmacologic thromboprophylaxis after...
questionsmedicales.fr › Procédures de chirurgie opératoire › Splénectomie › Early pharmacologic thromboprophylaxis after...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Thromboembolie › Thromboembolisme veineux › Early pharmacologic thromboprophylaxis after...