Khan Muhammad, Jehan Faisal, O'Keeffe Terence, Hamidi Mohammad, Kulvatunyou Narong, Tang Andrew, Gries Lynn, Joseph Bellal
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
J Surg Res. 2018 Dec;232:82-87. doi: 10.1016/j.jss.2018.06.022. Epub 2018 Jul 3.
Thromboprophylaxis with oral Xa inhibitors (Xa-Inh) are recommended after major orthopedic operation; however, its role in spine trauma is not well-defined. The aim of our study was to assess the impact of Xa-Inh in spinal trauma patients managed nonoperatively.
A 4-y (2013-2016) review of the Trauma Quality Improvement Program database. We included all patients with an isolated spine trauma (Spine-abbreviated injury scale ≥3 and other-abbreviated injury scale <3) who were managed nonoperatively and received thromboprophylaxis with either low molecular weight heparin (LMWH) or Xa-Inh. Patients were divided into two groups based on the thromboprophylactic agent received: Xa-Inh and LMWH and were matched in a 1:2 ratio using propensity score matching for demographics, vitals and injury parameters, and level of spine injury. Outcomes were rates of deep venous thrombosis, pulmonary embolism, and mortality.
We analyzed a total of 58,936 patients, of which 1056 patients (LMWH: 704, Xa-Inh: 352) were matched. Matched groups were similar in demographics, vital and injury parameters, length of hospital stay (P = 0.31), or time to thromboprophylaxis (P = 0.79). Patients who received Xa-Inh were less likely to develop a deep venous thrombosis (2.3% versus 5.7%, P < 0.01). There were no differences in the rate of pulmonary embolism (P = 0.73), postprophylaxis packed red blood cells transfusions (P = 0.79), postprophylaxis surgical decompression of spinal column (P = 0.75), and mortality rate (P = 0.77).
Oral Xa-Inh seems to be more effective as prophylactic pharmacologic agent for the prevention of deep venous thrombosis in patients with nonoperative spinal trauma compared to LMWH. The two drugs had similar safety profile. Further prospective trials should be performed to change current guidelines.
大型骨科手术后推荐使用口服Xa因子抑制剂（Xa-Inh）进行血栓预防；然而，其在脊柱创伤中的作用尚不明确。我们研究的目的是评估Xa-Inh对非手术治疗的脊柱创伤患者的影响。
对创伤质量改进计划数据库进行为期4年（2013 - 2016年）的回顾。我们纳入了所有单纯脊柱创伤患者（脊柱简明损伤量表≥3分且其他简明损伤量表<3分），这些患者接受非手术治疗并使用低分子量肝素（LMWH）或Xa-Inh进行血栓预防。根据所接受的血栓预防药物将患者分为两组：Xa-Inh组和LMWH组，并使用倾向评分匹配法按1:2的比例对人口统计学、生命体征和损伤参数以及脊柱损伤水平进行匹配。观察指标为深静脉血栓形成、肺栓塞和死亡率。
我们共分析了58936例患者，其中1056例患者（LMWH组：704例，Xa-Inh组：352例）进行了匹配。匹配组在人口统计学、生命体征和损伤参数、住院时间（P = 0.31）或开始血栓预防的时间（P = 0.79）方面相似。接受Xa-Inh的患者发生深静脉血栓的可能性较小（2.3%对5.7%，P < 0.01）。肺栓塞发生率（P = 0.73）、预防后浓缩红细胞输注率（P = 0.79）、预防后脊柱手术减压率（P = 0.75）和死亡率（P = 0.77）无差异。
与LMWH相比，口服Xa-Inh似乎是预防非手术脊柱创伤患者深静脉血栓更有效的预防性药物。两种药物的安全性相似。应进行进一步的前瞻性试验以改变当前指南。
