Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management

Is it safe?

Bellal Joseph, Viraj Pandit, Caitlyn Harrison, Dafney Lubin, Narong Kulvatunyou, Bardiya Zangbar, Andrew Tang, Terence OKeeffe, Donald J. Green, Lynn Gries, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

24 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)194-198
Number of pages5
JournalAmerican Journal of Surgery
Volume209
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Abdominal Injuries
Wounds and Injuries
Injury Severity Score
Hemorrhage
Blood Pressure
Enoxaparin
Propensity Score
Glasgow Coma Scale
Venous Thromboembolism
Blood Transfusion
Spleen
Outcome Assessment (Health Care)
Kidney
Safety
Liver

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management : Is it safe? / Joseph, Bellal; Pandit, Viraj; Harrison, Caitlyn; Lubin, Dafney; Kulvatunyou, Narong; Zangbar, Bardiya; Tang, Andrew; OKeeffe, Terence; Green, Donald J.; Gries, Lynn; Friese, Randall S.; Rhee, Peter.

In: American Journal of Surgery, Vol. 209, No. 1, 01.01.2015, p. 194-198.

Research output: Contribution to journalArticle

Joseph, B, Pandit, V, Harrison, C, Lubin, D, Kulvatunyou, N, Zangbar, B, Tang, A, OKeeffe, T, Green, DJ, Gries, L, Friese, RS & Rhee, P 2015, 'Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: Is it safe?', American Journal of Surgery, vol. 209, no. 1, pp. 194-198. https://doi.org/10.1016/j.amjsurg.2014.03.007
Joseph, Bellal ; Pandit, Viraj ; Harrison, Caitlyn ; Lubin, Dafney ; Kulvatunyou, Narong ; Zangbar, Bardiya ; Tang, Andrew ; OKeeffe, Terence ; Green, Donald J. ; Gries, Lynn ; Friese, Randall S. ; Rhee, Peter. / Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management : Is it safe?. In: American Journal of Surgery. 2015 ; Vol. 209, No. 1. pp. 194-198.
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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.",
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AU - Kulvatunyou, Narong

AU - Zangbar, Bardiya

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Green, Donald J.

AU - Gries, Lynn

AU - Friese, Randall S.

AU - Rhee, Peter

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N2 - 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.

AB - 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.

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