Kim Dennis Yong, Kobayashi Leslie, Chang David, Fortlage Dale, Coimbra Raul
From the Department of Surgery, Division of Trauma, Surgical Critical Care, and Burns, University of California San Diego Health Sciences, San Diego, CA.
Spine (Phila Pa 1976). 2015 Mar 1;40(5):299-304. doi: 10.1097/BRS.0000000000000754.
Retrospective cohort study.
To examine the impact of early (<48 hr) versus late (≥48 hr) initiation of pharmacological venous thromboembolism (VTE) prophylaxis on outcomes and complications among trauma patients undergoing operative fixation of spine fractures.
VTE complications are associated with poor outcomes after trauma. Although pharmacological prophylaxis decreases the risk of VTE after trauma, concerns regarding bleeding-related complications among certain patient subgroups persist. At present, there are limited data regarding the safety of early VTE prophylaxis in trauma patients undergoing operative fixation of spine fractures.
We performed a 5-year retrospective analysis of our level 1 trauma center registry to identify consecutive patients undergoing operative fixation of spine fractures. Demographics, injury patterns and severity, details of operative procedures, timing of administration of VTE prophylaxis, and outcomes were analyzed. Patients receiving early VTE prophylaxis were compared with patients receiving late VTE prophylaxis. Multivariate analysis was performed to identify independent predictors of VTE.
Of 1432 patients with spine fractures, 206 patients (14.4%) underwent operative fixation. Forty-eight (23.3%) received early VTE prophylaxis and 158 (76.7%) received late VTE prophylaxis. No patient developed an epidural hematoma or postoperative bleeding necessitating intervention in either group. Thirteen patients (6.2%) developed VTE, of which 12 occurred in the late VTE prophylaxis group. Age 45 years or more (odds ratio = 5.12, 95% confidence interval = 1.01-25.94, P = 0.048) and traumatic brain injury (odds ratio = 6.94, 95% confidence interval = 1.19-40.35, P = 0.031) were independently associated with an increased risk for VTE.
Pharmacological VTE prophylaxis initiated within 48 hours of operative fixation of traumatic spine fractures seems to be safe and is not associated with an increased risk of bleeding or neurological complications. Large, multicenter prospective studies are required to further define the efficacy and safety of an early pharmacological VTE prophylaxis strategy in this at-risk patient population.
回顾性队列研究。
探讨创伤性脊柱骨折手术固定患者早期（<48小时）与晚期（≥48小时）开始药物性静脉血栓栓塞症（VTE）预防对结局和并发症的影响。
VTE并发症与创伤后不良结局相关。虽然药物预防可降低创伤后VTE的风险，但某些患者亚组中与出血相关并发症的担忧仍然存在。目前，关于创伤性脊柱骨折手术固定患者早期VTE预防安全性的数据有限。
我们对一级创伤中心登记处进行了为期5年的回顾性分析，以确定连续接受创伤性脊柱骨折手术固定的患者。分析了人口统计学、损伤模式和严重程度、手术细节、VTE预防用药时间以及结局。将接受早期VTE预防的患者与接受晚期VTE预防的患者进行比较。进行多变量分析以确定VTE的独立预测因素。
在1432例脊柱骨折患者中，206例（14.4%）接受了手术固定。48例（23.3%）接受早期VTE预防，158例（76.7%）接受晚期VTE预防。两组均无患者发生硬膜外血肿或需要干预的术后出血。13例患者（6.2%）发生VTE，其中12例发生在晚期VTE预防组。年龄45岁及以上（比值比=5.12，95%置信区间=1.01-25.94，P=0.048）和创伤性脑损伤（比值比=6.94，95%置信区间=1.19-40.35，P=0.031）与VTE风险增加独立相关。
创伤性脊柱骨折手术固定后48小时内开始药物性VTE预防似乎是安全的，且与出血或神经并发症风险增加无关。需要大型多中心前瞻性研究来进一步确定早期药物性VTE预防策略在这一高危患者群体中的疗效和安全性。
3级。
