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Am J Surg. 2015 Jan;209(1):194-8. doi: 10.1016/j.amjsurg.2014.03.007. Epub 2014 May 4.

Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: is it safe?

Author information

  • 1Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA. Electronic address: bjoseph@surgery.arizona.edu.
  • 2Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.

Abstract

BACKGROUND:

The aim of this study was to compare the safety of early (≤48 hours), intermediate (48 to 72 hours), and late (≥72 hours) venous thromboembolism prophylaxis in patients with blunt abdominal solid organ injury managed nonoperatively.

METHODS:

We performed a 6-year (2006 to 2011) retrospective review of all trauma patients with blunt abdominal solid organ injuries. Patients were matched using propensity score matching in a 2:1:1 (early:intermediate:late) for age, gender, systolic blood pressure, Glasgow Coma Scale, Injury Severity Score, and type and grade of organs injured. Our primary outcome measures were: hemorrhage complications and need for intervention (operative intervention and/or angioembolization).

RESULTS:

A total of 116 patients (58 early, 29 intermediate, and 29 late) were included. There were no differences in age (P = .5), Injury Severity Score (P = .6), type (P = .1), and grade of injury of the organ (P = .6) between the 3 groups. There were 67 liver (43.2%), 63 spleen (40.6%), 49 kidney (31.6%), and 24 multiple solid organ (15.4%) injuries. There was no difference in operative intervention (P = .8) and postprophylaxis blood transfusion (P = .3) between the 3 groups.

CONCLUSIONS:

Early enoxaparin-based anticoagulation may be a safe option in trauma patients with blunt solid organ injury. This study showed no significant correlation between early anticoagulation and development of bleeding complications.

Copyright © 2015 Elsevier Inc. All rights reserved.

KEYWORDS:

Bleeding complications; Blunt solid organ injury; Failure of nonoperative management; Timing of venous thromboembolism prophylaxis; Venous thromboembolism prophylaxis

PMID:
24928334
[PubMed - in process]
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