Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
J Surg Res. 2021 Feb;258:119-124. doi: 10.1016/j.jss.2020.08.029. Epub 2020 Sep 30.
Thromboprophylaxis in patients with spinal trauma is often delayed due to the risk of bleeding and expansion of the intraspinal hematoma (ISH). Our study aimed to assess the safety of early initiation of thromboprophylaxis in patients with operative spinal trauma (OST).
We performed a 2014-2017 retrospective analysis of our level I trauma registry and included all adult patients with isolated OST who received low-molecular-weight heparin (LMWH). Patients were stratified into early (≤48 h) and late (>48 h) initiation of LMWH groups. Outcomes were a decline in hemoglobin level, packed red blood cell transfusion, and progression of ISH. We performed multivariable logistic regression.
We identified a total of 526 patients (early: 332, late: 194). Mean age was 46 ± 22y, and the median spine abbreviated injury scale was 3 [2-4]. After thromboprophylaxis, 1.5% (8) of the patients had progression of ISH and 1% (5) underwent surgical decompression of the spinal canal. There was no difference between the two groups regarding the rate of postprophylaxis ISH progression (1.5% versus 1.6%, P = 0.11) or surgical decompression (0.9% versus 1.1%, P = 0.19). Patients who received LMWH within 48 hrs had a lower incidence of clinically significant deep vein thrombosis (2.4% versus 6.8%, P = 0.02), but no difference in pulmonary embolism (0.6% versus 1.6%, P = 0.33) or mortality (1.2% versus 1.5%, P = 0.41). On regression analysis, there was no difference regarding decline in hemoglobin levels (β = 0.079, [-0.253 to 1.025]; P = 0.23) or number of packed red blood cell units transfused (β = -0.011, [-0.298 to 0.471]; P = 0.35).
Thromboprophylaxis with LMWH within the first 48 h in patients with OST is safe and efficacious. Prospective studies are needed to further validate their risk-benefit ratio.
Level III therapeutic.
由于出血和椎管内血肿（IS H）扩大的风险，脊髓创伤患者的血栓预防常被延迟。我们的研究旨在评估在接受手术治疗的脊髓创伤（OST）患者中早期开始血栓预防的安全性。
我们对 2014-2017 年的 I 级创伤登记处进行了回顾性分析，纳入了所有接受低分子肝素（LMWH）治疗的单纯 OST 成年患者。患者分为 LMWH 早期（≤48 h）和晚期（>48 h）启动组。结果为血红蛋白水平下降、红细胞悬液输注和 IS H进展。我们进行了多变量逻辑回归分析。
共纳入 526 例患者（早期：332 例，晚期：194 例）。平均年龄为 46±22 岁，脊髓损伤严重程度评分中位数为 3 [2-4]。在进行血栓预防后，有 1.5%（8 例）的患者出现 IS H 进展，1%（5 例）需要进行椎管减压手术。两组患者的预防性 IS H 进展发生率（1.5%比 1.6%，P=0.11）或手术减压率（0.9%比 1.1%，P=0.19）无差异。在 48 小时内接受 LMWH 治疗的患者，临床显著深静脉血栓形成的发生率较低（2.4%比 6.8%，P=0.02），但肺栓塞发生率（0.6%比 1.6%，P=0.33）或死亡率（1.2%比 1.5%，P=0.41）无差异。回归分析显示，血红蛋白水平下降（β=0.079，[-0.253 至 1.025]；P=0.23）或红细胞悬液输注单位数（β=-0.011，[-0.298 至 0.471]；P=0.35）无差异。
OST 患者在伤后 48 小时内使用 LMWH 进行血栓预防是安全有效的。需要前瞻性研究进一步验证其风险效益比。
治疗 III 级。
