孤立性高分级钝性脾损伤的早期静脉血栓栓塞预防。

Early Venous Thromboembolism Prophylaxis for Isolated High-Grade Blunt Splenic Injury.

机构信息

Division of Acute Care Surgery, University of Southern California, Los Angeles, California.

出版信息

J Surg Res. 2019 Nov;243:340-345. doi: 10.1016/j.jss.2019.05.060. Epub 2019 Jul 2.

DOI:10.1016/j.jss.2019.05.060

PMID:31277010

Abstract

BACKGROUND

Nonoperative management (NOM) has become more common in hemodynamically stable patients with high-grade blunt splenic injury. However, there are no widely accepted guidelines for an optimal and safe timeframe for the initiation of venous thromboembolism (VTE) prophylaxis. The purpose of this study was to explore the association between the timing of VTE prophylaxis initiation and NOM failure rate in isolated high-grade blunt splenic injury.

METHODS

We utilized the American College of Surgeons Trauma Quality Improvement Program database (2013-2014) to identify adult patients who underwent NOM for isolated high-grade blunt splenic injuries (grades 3-5). The incidence of NOM failure after the initiation of VTE prophylaxis was compared between two groups: VTE prophylaxis <48 h after admission (early prophylaxis group), and ≥48 h (late prophylaxis group).

RESULTS

A total of 816 patients met the inclusion criteria. Of those, VTE prophylaxis was not administered in 525 patients (64.3%), whereas VTE prophylaxis was given <48 h and ≥48 h after admission in 144 and 147 patients, respectively. There was no significant difference in the NOM failure rate after the initiation of VTE prophylaxis between the early and late prophylaxis groups (3.5% versus 3.4%, P = 1.00). In the multiple logistic regression analysis, early initiation of VTE prophylaxis was not significantly associated with NOM failure (OR: 1.32, 95% CI 0.35-4.93, P = 0.68).

CONCLUSIONS

The results of our study suggest that early initiation of VTE prophylaxis (<48 h) does not increase the risk of NOM failure in patients with isolated high-grade blunt splenic injury.

摘要

背景

血流动力学稳定的高分级钝性脾损伤患者越来越倾向于接受非手术治疗（NOM）。然而，目前还没有广泛接受的指南来确定启动静脉血栓栓塞症（VTE）预防的最佳和安全时间窗。本研究的目的是探讨 VTE 预防起始时间与孤立性高分级钝性脾损伤 NOM 失败率之间的关系。

方法

我们利用美国外科医师学会创伤质量改进计划数据库（2013-2014 年），确定了接受 NOM 治疗的孤立性高分级钝性脾损伤（3-5 级）的成年患者。比较了 VTE 预防开始后 NOM 失败的发生率在两组之间：入院后 <48 小时（早期预防组）和≥48 小时（晚期预防组）。

结果

共有 816 名患者符合纳入标准。其中，525 名患者（64.3%）未接受 VTE 预防，144 名和 147 名患者分别在入院后 <48 小时和≥48 小时接受了 VTE 预防。在开始 VTE 预防后，早期和晚期预防组之间的 NOM 失败率没有显著差异（3.5%比 3.4%，P=1.00）。在多因素逻辑回归分析中，早期启动 VTE 预防与 NOM 失败无显著相关性（OR：1.32，95%CI 0.35-4.93，P=0.68）。