Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California.
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California.
J Surg Res. 2021 Feb;258:272-277. doi: 10.1016/j.jss.2020.08.077. Epub 2020 Oct 8.
The ideal time for pharmacologic venous thromboembolism (VTE) prophylaxis initiation after pelvic fracture is controversial. This prospective study evaluated the safety and efficacy of early VTE prophylaxis after blunt pelvic trauma.
Patients presenting to our American College of Surgeons-verified level I trauma center (between December 1, 2016 and November 30, 2017) with blunt pelvic fracture were prospectively screened. Exclusion criteria were emergency department death, immediate operative intervention, transfers, home anticoagulation, pregnancy, and patients receiving no pharmacologic VTE prophylaxis during hospitalization. Patients were dichotomized into study groups based on VTE prophylaxis initiation time ≤48 h (early prophylaxis [EP]) versus >48 h (late prophylaxis [LP]) after emergency department arrival. Demographics, injury data, clinical data, VTE prophylaxis agent and initiation time, and outcomes were compared.
After exclusions, 146 patients were identified: 74 (51%) patients in EP group and 72 (49%) patients in LP group. Pelvic fracture severity was comparable between groups (Abbreviated Injury Scale extremity score 2 [2-3] versus 2 [2-3]; P = 0.610). On univariate analysis, deep vein thrombosis rates were higher after LP (n = 5, 7% versus 0, 0%; P = 0.027). Pulmonary embolism rates were similar (n = 2, 3% versus n = 3, 4%; P = 1.000). No patient required delayed intervention for bleeding, and postprophylaxis blood transfusion was comparable between groups (P > 0.05). On multivariate analysis, timing of pharmacologic VTE prophylaxis initiation was not associated with VTE development (odds ratio, 0.647; P = 0.999). Pelvic angioembolization was independently associated with VTE (odds ratio, 1.296; P = 0.044).
Early initiation of pharmacologic VTE prophylaxis after blunt pelvic fracture is safe. Although EP initiation did not reduce the rate of VTE, these data identify angioembolization as an independent risk factor for VTE. Patients with blunt pelvic fracture who undergo angioembolization may therefore represent a high-risk population who may especially benefit from EP.
在骨盆骨折后开始药物预防静脉血栓栓塞症（VTE）的理想时间存在争议。本前瞻性研究评估了钝性骨盆创伤后早期 VTE 预防的安全性和有效性。
我们前瞻性筛选了 2016 年 12 月 1 日至 2017 年 11 月 30 日期间到我们的美国外科医师学院认证的一级创伤中心就诊的钝性骨盆骨折患者。排除标准为急诊科死亡、即刻手术干预、转院、家庭抗凝、妊娠以及患者在住院期间未接受任何药物 VTE 预防。根据急诊科到达后开始 VTE 预防的时间≤48 小时（早期预防 [EP]）或>48 小时（晚期预防 [LP]）将患者分为研究组。比较了人口统计学、损伤数据、临床数据、VTE 预防药物和开始时间以及结局。
排除后，共确定了 146 名患者：74 名（51%）患者在 EP 组，72 名（49%）患者在 LP 组。两组骨盆骨折严重程度相似（损伤严重程度评分四肢 2 [2-3] 与 2 [2-3]；P=0.610）。单因素分析显示，LP 后深静脉血栓形成率较高（n=5，7%与 0，0%；P=0.027）。肺栓塞发生率相似（n=2，3%与 n=3，4%；P=1.000）。无患者因出血需要延迟干预，且预防后输血在两组间相似（P>0.05）。多因素分析显示，药物 VTE 预防开始时间与 VTE 发展无关（比值比，0.647；P=0.999）。骨盆血管栓塞术与 VTE 独立相关（比值比，1.296；P=0.044）。
钝性骨盆骨折后早期开始药物 VTE 预防是安全的。尽管 EP 起始并未降低 VTE 发生率，但这些数据确定血管栓塞术是 VTE 的独立危险因素。接受血管栓塞术的钝性骨盆骨折患者可能代表高危人群，尤其可能从 EP 中获益。
