Highlights
- •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.
Abstract
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.
Keywords
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Article info
Publication history
Published online: February 14, 2019
Footnotes
☆Presented at the 76th Annual Meeting for the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery.
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
