- •Early (<72 h) VTE prophylaxis after severe pelvic fracture is associated with lower rates of VTE.
- •LMWH, relative to unfractionated heparin, is associated with lower rates of VTE and lower mortality.
- •In contemporary practice, early VTE prophylaxis is given safely in nearly ¾ of patients with severe pelvic fractures.
Introduction: Optimal timing of pharmacological thromboprophylaxis (VTEp) in patients with severe pelvic fractures remains unclear. The high risk of venous thromboembolic (VTE) complications after severe pelvic fractures supports early VTEp however concern for fracture-associated hemorrhage can delay initiation. Patients with pelvic fractures also frequently have additional injuries that complicate the interpretation of the VTEp safety profiles. To minimize this problem, the study included only patients with isolated severe pelvic fractures.
Materials and methods: The Trauma Quality Improvement Program was used to collect patients with blunt severe pelvic fractures (AIS > 3) who received VTEp with unfractionated heparin (UH) or low-molecular-weight heparin (LMWH). Patients with head, chest, spine, and abdominal injuries AIS > 3, or those with angio or operative intervention prior to VTEp were excluded. The study population was stratified according to timing of VTEp, early (<48 h) and late (>48 h). Outcomes included in-hospital mortality and VTE.
Results: 2752 patients were included in the study. Overall, 2007 patients (72.9%) received early VTEp, while 745 (27.1%) received late VTEp. LMWH was administered in 2349 (85.4%) and UH in 403 (14.6%).
Late VTEp was associated with significantly higher incidence of VTE (4.3% vs. 2.2%, p = 0.004). Logistic regression identified late VTEp as an independent risk factor for VTE (OR 1.93, p = 0.009) and mortality (OR 4.03, p = 0.006). LMWH was an independent factor protective for both VTE and mortality (OR 0.373, p < 0.001, OR 0.266, p = 0.009, respectively).
Conclusion: In isolated severe pelvic fractures, early VTEp is independently associated with improved survival and fewer VTE. LMWH may be preferred over UH for this purpose.
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Published online: February 14, 2019
☆Presented at the 76th Annual Meeting for the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery.
© 2019 Elsevier Ltd. All rights reserved.