Wang Eugene, Inaba Kenji, Cho Jayun, Byerly Saskya, Rowe Vincent, Benjamin Elizabeth, Lam Lydia, Demetriades Demetrios
Division of Trauma and Critical Care, University of Southern California, Los Angeles, California, USA.
Am Surg. 2016 Oct;82(10):968-972.
Thrombosis is a devastating complication after repair of traumatic vascular injury. Although thrombosis rates have been described, the value of anticoagulation in preventing postrepair thrombosis is unknown. We hypothesize that postoperative anticoagulation reduces thrombosis rates. A total of 1524 consecutive patients with traumatic arterial injuries from January 2005 to June 2015 were identified, and 381 patients underwent the following repair types: direct suture of vessel wall, primary anastomosis, extra-anatomic reconstruction, tissue and synthetic interposition reconstruction. Twenty six patients received postoperative heparin at therapeutic levels, and 29 patients received postoperative aspirin for five consecutive days. The heparin and aspirin groups were matched with patients without postoperative anticoagulation by the following variables: anatomic arterial injury, type of vascular repair, and age. These groups were then compared using the following outcome measures: mortality, thrombosis of repaired vessel, amputation, hemorrhage, cerebral vascular accident, and extremity compartment syndrome. The demographics between the heparin, aspirin, and respectively matched groups were not statistically different. There was no statistically significant difference in the rate of thrombosis, bleeding, compartment syndrome, cerebral vascular accident, limb amputation, or mortality. Although there was no increase in bleeding complications with the use of heparin or aspirin, there was also no impact on the rate of thrombosis.
血栓形成是创伤性血管损伤修复术后一种严重的并发症。尽管已有血栓形成发生率的相关描述，但抗凝治疗在预防修复术后血栓形成中的价值尚不清楚。我们推测术后抗凝治疗可降低血栓形成发生率。确定了2005年1月至2015年6月期间共1524例连续性创伤性动脉损伤患者，其中381例患者接受了以下修复方式：血管壁直接缝合、一期吻合、解剖外重建、组织和人工血管间置重建。26例患者接受了治疗剂量的术后肝素治疗，29例患者连续5天接受了术后阿司匹林治疗。肝素组和阿司匹林组与未接受术后抗凝治疗的患者在以下变量上进行匹配：动脉解剖损伤、血管修复类型和年龄。然后使用以下结局指标对这些组进行比较：死亡率、修复血管的血栓形成、截肢、出血、脑血管意外和肢体骨筋膜室综合征。肝素组、阿司匹林组及其各自匹配组之间的人口统计学特征无统计学差异。在血栓形成率、出血、骨筋膜室综合征发生率、脑血管意外、肢体截肢或死亡率方面无统计学显著差异。尽管使用肝素或阿司匹林并未增加出血并发症，但对血栓形成率也没有影响。
