Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, FL.
Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, FL.
Surgery. 2024 May;175(5):1418-1423. doi: 10.1016/j.surg.2024.01.001. Epub 2024 Feb 27.
Thromboprophylaxis after blunt splenic trauma is complicated by the risk of bleeding, but the risk after angioembolization is unknown. We hypothesized that earlier thromboprophylaxis initiation was associated with increased bleeding complications without mitigating venous thromboembolism events.
All blunt trauma patients who underwent splenic angioembolization within 24 hours of arrival were identified from the American College of Surgeons Trauma Quality Improvement Program datasets from 2017 to 2019. Cases with <24-hour length of stay, other serious injuries, and surgery before angioembolization were excluded. Venous thromboembolism was defined as deep vein thrombosis or pulmonary embolism. Bleeding complications were defined as splenic surgery, additional embolization, or blood transfusion after thromboprophylaxis initiation. Data were compared with χ analysis and multivariate logistic regression at P < .05.
In 1,102 patients, 84% had American Association for the Surgery of Trauma grade III to V splenic injuries, and 73% received thromboprophylaxis. Splenic surgery after angioembolization was more common in those with thromboprophylaxis initiation within the first 24 hours (5.7% vs 1.7%, P = .007), whereas those with the initiation of thromboprophylaxis after 72 hours were more likely to have a pulmonary embolism (2.3% vs 0.2%, P = .001). Overall, venous thromboembolism increased considerably when thromboprophylaxis was initiated after day 3. In multivariate analysis, time to thromboprophylaxis initiation was associated with bleeding (odds ratio 0.74 [95% confidence interval 0.58-0.94]) and venous thromboembolism complications (odds ratio 1.5 [95% confidence interval 1.20-1.81]).
This national study evaluates bleeding and thromboembolic risk to elucidate the specific timing of thromboprophylaxis after splenic angioembolization. Initiation of thromboprophylaxis between 24 and 72 hours achieves the safest balance in minimizing bleeding and venous thromboembolism risk, with 48 hours particularly serving as the ideal time for protocolized administration.
钝性脾外伤后的血栓预防会增加出血风险，但血管栓塞后的风险尚不清楚。我们假设，早期开始血栓预防会增加出血并发症的风险，而不会减少静脉血栓栓塞事件。
从美国外科医师学院创伤质量改进计划 2017 年至 2019 年的数据集中，确定了 24 小时内接受脾血管栓塞治疗的所有钝性创伤患者。排除了 24 小时内住院时间<、其他严重损伤和血管栓塞前手术的病例。静脉血栓栓塞症定义为深静脉血栓或肺栓塞。出血并发症定义为开始血栓预防后进行脾切除术、额外栓塞或输血。数据比较采用 χ 分析和多变量逻辑回归，P <.05。
在 1102 例患者中，84%的患者美国外科医师协会创伤分级为 III 至 V 级脾损伤，73%的患者接受了血栓预防。血管栓塞后行脾切除术的患者，在 24 小时内开始血栓预防的比例较高（5.7% vs 1.7%，P <.007），而在 72 小时后开始血栓预防的患者发生肺栓塞的比例较高（2.3% vs 0.2%，P <.001）。总的来说，在第 3 天之后开始进行血栓预防，静脉血栓栓塞症的风险显著增加。多变量分析显示，开始进行血栓预防的时间与出血（比值比 0.74[95%置信区间 0.58-0.94]）和静脉血栓栓塞并发症（比值比 1.5[95%置信区间 1.20-1.81]）相关。
这项全国性研究评估了脾血管栓塞后出血和血栓栓塞风险，以阐明血栓预防的具体时间。在 24 至 72 小时之间开始进行血栓预防，可以在最小化出血和静脉血栓栓塞风险方面达到最安全的平衡，尤其是在 48 小时时，最适合进行方案化给药。
