Highlights
- •Compared with UH, LMWH was associated with lower odds of VTE and death.
- •DOACs were associated with lower risk of DVT compared with LMWH.
- •Early VTE chemoprophylaxis was better than late administration in terms of VTE and death.
- •Many patients with acetabular fractures are underdosed with LMWH, with inadequate aFXa levels.
Abstract
Background
It is unclear which pharmacological agents, and at what dosage and timing, are most
effective for venous thromboembolism (VTE) prophylaxis in patients with pelvic/acetabular
fractures.
Methods
We searched the Cochrane Database of Systematic Reviews, Embase, Web of Science, EBSCO,
and PubMed on October 3, 2020, for English-language studies of VTE prophylaxis in
patients with pelvic/acetabular fractures. We applied no date limits. We included
studies that compared efficacy of pharmacological agents for VTE prophylaxis, timing
of administration of such agents, and/or dosage of such agents. We recorded interventions,
sample sizes, and VTE incidence, including deep vein thrombosis (DVT) and pulmonary
embolism.
Results
Two studies (3604 patients) compared pharmacological agents, reporting that patients
who received direct oral anticoagulants (DOACs) were less likely to develop DVT than
those who received low molecular weight heparin (LMWH) (p < 0.01). Compared with unfractionated
heparin (UH), LMWH was associated with lower odds of VTE (odds ratio [OR] = 0.37,
95% confidence interval [CI]: 0.22–0.63) and death (OR = 0.27, 95% CI: 0.10–0.72).
Three studies (3107 patients) compared timing of VTE prophylaxis, reporting that late
prophylaxis was associated with higher odds of VTE (OR = 1.9, 95% CI: 1.2–3.2) and
death (OR = 4.0, 95% CI: 1.5–11) and higher rates of symptomatic DVT (9.2% vs. 2.5%,
p = 0.03; and 22% vs. 3.1%, p = 0.01). One study (31 patients) investigated dosage of VTE prophylaxis, reporting
that a higher proportion of patients with acetabular fractures were underdosed (23%
of patients below range of anti–Factor Xa [aFXa] had acetabular fractures vs. 4.8%
of patients within adequate range of aFXa, p<0.01).
Conclusions
: Early VTE chemoprophylaxis (within 24 or 48 h after injury) was better than late
administration in terms of VTE and death. Many patients with acetabular fractures
are underdosed with LMWH, with inadequate aFXa levels. Compared with UH, LMWH was
associated with lower odds of VTE and death. DOACs were associated with lower risk
of DVT compared with LMWH.
Level of Evidence
: III, systematic review of retrospective cohort studies.
Keywords
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Article info
Publication history
Published online: February 05, 2022
Accepted:
January 29,
2022
Footnotes
This study was exempt from institutional review board approval.
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
