Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Surgery, 12326University of Tennessee Health Science Center, Memphis, TN, USA.
Am Surg. 2022 Jan;88(1):126-132. doi: 10.1177/0003134820982577. Epub 2020 Dec 23.
Venous thromboembolism (VTE) is a common cause of serious morbidity and mortality. While chemoprophylaxis decreases VTE, there is the theoretical risk of increased hemorrhagic complications. The purpose of this study was to evaluate the impact of preoperative anticoagulation on VTE and bleeding complications in patients with blunt pelvic fractures requiring operative fixation.
Patients with blunt pelvic fractures requiring operative fixation over 10.5 years were identified. Patients were stratified by age, severity of shock, operative management, and timing and duration of anticoagulation. Outcomes were evaluated to determine risk factors for bleeding complications and VTE.
310 patients were identified: 212 patients received at least one dose of preoperative anticoagulation and 98 received no preoperative anticoagulation. 68% were male with a mean injury severity score and Glasgow Coma Scale of 26 and 13, respectively. Bleeding complications occurred in 24 patients and 21 patients suffered VTE. Patients with VTE had a greater initial severity of shock (resuscitation transfusions, 4 vs. 2 units, = .02). Despite longer time to mobilization (4 vs. 3 days, = .001), patients who received their scheduled preoperative doses within 48 hours of arrival had no significant differences in the number of deep vein thrombosis events (5.2% vs. 5.7%, = .99), but fewer episodes of pulmonary embolism (PE) (1.5% vs. 6.8%, = .03) with no difference in bleeding complications (7.5% vs. 8%, = .87) compared to either patients who had their doses held until after 48 hours of arrival or received no preoperative anticoagulation.
Preoperative anticoagulation prior to pelvic fixation reduced the risk of PE without increasing bleeding complications. Preoperative anticoagulation is safe and beneficial in this group of patients.
静脉血栓栓塞症（VTE）是导致严重发病率和死亡率的常见原因。尽管化学预防可降低 VTE，但存在出血并发症增加的理论风险。本研究旨在评估术前抗凝对需要手术固定的钝性骨盆骨折患者的 VTE 和出血并发症的影响。
确定了 10.5 年以上需要手术固定的钝性骨盆骨折患者。根据年龄、休克严重程度、手术管理以及抗凝的时机和持续时间对患者进行分层。评估结果以确定出血并发症和 VTE 的危险因素。
确定了 310 例患者：212 例患者接受了至少一剂术前抗凝，98 例患者未接受术前抗凝。68%为男性，平均损伤严重程度评分和格拉斯哥昏迷评分分别为 26 和 13。24 例患者发生出血并发症，21 例患者发生 VTE。发生 VTE 的患者初始休克严重程度更高（复苏输血，4 与 2 单位， =.02）。尽管动员时间更长（4 与 3 天， =.001），但在入院后 48 小时内接受预定术前剂量的患者，深静脉血栓形成事件的数量没有显著差异（5.2%与 5.7%， =.99），但肺栓塞（PE）的发作次数更少（1.5%与 6.8%， =.03），出血并发症无差异（7.5%与 8%， =.87），与在入院后 48 小时或未接受术前抗凝的患者相比。
在骨盆固定之前进行术前抗凝可降低 PE 的风险，而不会增加出血并发症。在这群患者中，术前抗凝是安全且有益的。
