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OPTIMAL TIMING OF INITIATION OF THROMBOPROPHYLAXIS IN SPINE TRAUMA MANAGED OPERATIVELY: A NATIONWIDE PROPENSITY MATCHED ANALYSIS OF TRAUMA QUALITY IMPROVEMENT PROGRAM.

Research paper by Muhammad M Zeeshan, Muhammad M Khan, Terence T O'Keeffe, Nina N Pollack, Mohammad M Hamidi, Narong N Kulvatunyou, Joseph V JV Sakran, Lynn L Gries, Bellal B Joseph

Indexed on: 04 Apr '18Published on: 04 Apr '18Published in: The journal of trauma and acute care surgery



Abstract

Patients with spinal trauma are at high-risk for venous-thromboembolism(VTE). Guidelines recommend prophylactic anticoagulation but they are unclear on timing of initiation of thromboprophylaxis. The aim of our study was to assess the impact of early vs late initiation of venous thromboprophylaxis in patients with spinal trauma who underwent operative intervention. We performed a 2-year (2013-14) review of patients with isolated spine trauma (S-AIS≥3 and no other injury in another body region with AIS>2) who underwent operative intervention and received thromboprophylaxis post-operatively. Patients were divided into two groups based on the timing of initiation of thromboprophylaxis: early(<48 hours) and late(≥48 hours); and were matched in a 1:1 ratio using propensity-score-matching(PSM) for demographics, admission vitals, injury parameters, type of operative intervention, hospital course, and type of prophylaxis(LMWH vs UFH). Outcomes were rates of deep-venous thrombosis(DVT) and/or pulmonary embolism(PE), red-cell transfusions, the rate of operative interventions for spinal cord decompression and mortality after initiation of thromboprophylaxis. 9585 patients underwent operative intervention and received anticoagulants, of which 3554 patients (early:1772, late:1772) were matched. Matched groups were similar in demographics, injury parameters, ED-Vitals, hospital LOS, rates of IVC filter placement and time to operative procedure. Patients who received thromboprophylaxis within 48 hours of operative intervention, unlike those who did not, were less likely to develop DVT (2.1% vs. 10.8%, p<0. 01). However, the rate of PE was similar in both groups (p=0.75). Additionally, there was no difference in post-prophylaxis red cell transfusion requirements (p=0.61), rate of post-prophylaxis decompressive procedure on the spinal cord (p=0.27), and mortality (p=0.53). Early VTE prophylaxis is associated with decreased rates of DVT in patients with operative spinal trauma without increasing the risk of bleeding and mortality. VTE prophylaxis should be initiated within 48-hours of surgery to reduce the risk of DVT in this high-risk patient population. Level III, Therapeutic studies.