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Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin for Thromboprophylaxis in Nonoperative Pelvic Fractures.

Research paper by Mohammad M Hamidi, Muhammad M Zeeshan, Joseph V JV Sakran, Narong N Kulvatunyou, Terence T O'Keeffe, Ashley A Northcutt, El Rasheid ER Zakaria, Andrew A Tang, Bellal B Joseph

Indexed on: 26 Oct '18Published on: 26 Oct '18Published in: Journal of The American College of Surgeons



Abstract

Patients with pelvic fractures are prone to venous-thromboembolic(VTE) complications. Recent literature shows superiority of direct-oral-anticoagulants(DOACs) over low-molecular-weight-heparin (LMWH) for thromboprophylaxis in patients undergoing orthopedic surgeries. The aim of our study was to compare in-hospital outcomes for DOACs vs. LMWH in patients with non-operative pelvic fractures. We performed 2-year (2015-16) analysis of the American College of Surgeons-Trauma Quality Improvement Program(ACS-TQIP) database. We included all adult patients with isolated blunt pelvic fractures who were managed non-operatively and received thromboprophylaxis with either LMWH or DOACs (Factor-Xa inhibitor or direct thrombin inhibitor). Patients were divided into two groups based on receipt of DOACs vs. LMWH and were propensity-score-matched in a 1:2 ratio to control for possible confounding factors. Primary outcomes were DVT and/or PE. Secondary outcomes were pRBC transfusions, intervention for hemorrhage control and in-hospital mortality after initiation of thromboprophylaxis. We identified 20,692 patients with pelvic fractures. 7,312 patients with isolated pelvic fractures were included of which 852 patients were matched(DOACs:284; LMWH:568). Mean age was 43.2±15years, median Injury-Severity-Score was14[10-18]. Matched groups were similar in demographics, vitals, injury parameters, and timing of initiation of thromboprophylaxis. Overall 5.2% of patients had DVT, 1.4% PE and 1.3% died. Patients who received DOACs were less likely to develop DVT(1.8%vs.6.9%,p<0.01) compared to LMWH. There was no difference in PE (p=0.85) or in-hospital mortality(p=0.79) between the two groups. Similarly, there was no difference in post-prophylaxis blood transfusion, and post-prophylaxis intervention for hemorrhage control. In patients with non-operative pelvic fractures, DOACs were associated with a reduced rate of DVT versus LMWH without increasing the risk of bleeding complications. No association was found between the type of thromboprophylactic agent and rates of PE or in-hospital mortality. Copyright © 2018. Published by Elsevier Inc.

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