Early thromboprophylaxis with low-molecular-weight heparin is safe in patients with pelvic fracture managed nonoperatively

• Published in: The Journal of surgical research 2017-11, Vol.219, p.360-365
• Main Authors: Jehan, Faisal, O'Keeffe, Terence, Khan, Muhammad, Chi, Albert, Tang, Andrew, Kulvatunyou, Narong, Gries, Lynn, Joseph, Bellal
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; DVT; Female; Fractures, Bone - complications; Heparin, Low-Molecular-Weight - administration & dosage; Heparin, Low-Molecular-Weight - adverse effects; Humans; LMWH; Male; Middle Aged; nonoperative; Pelvic Bones - injuries; Pelvic Fracture; Retrospective Studies; Thromboprophylaxis; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2017.06.049

Early initiation of thromboprophylaxis is highly desired in pelvic fracture patients, but it is often delayed due to the fear of hemorrhage. Aim of our study was to assess the safety of early initiation of venous thromboprophylaxis in patients with pelvic trauma managed nonoperatively. Three-year (2010-2012) retrospective study of trauma patients with pelvic fractures who were managed nonoperatively and received thromboprophylaxis with low-molecular-weight heparin (LMWH). Patients were stratified in two groups based on the timing of initiation of prophylaxis; early (initiation within first 24 h) and late (after 24 h). Primary outcome measures included decrease in hemoglobin (Hb) levels, number of packed red blood cell (pRBC) units transfused, and the need for hemorrhage control (operative or angioembolization) after initiation of prophylaxis. Regression analysis was performed. 255 patients were included (158 in early and 97 in late group). Mean ± standard deviation age was 48.2 ± 23.3 y, and 50.6% were male. After adjusting for confounders, there was no difference between the two groups in the decrease in Hb levels (b = 0.087, 95% confidence interval [CI] = −0.253 to 1.025; P = 0.23) or pRBC units transfused (b = −0.005, 95% CI = −0.366 to 0.364; P = 0.75).One patient required hemorrhage control postprophylaxis and belonged to the late group. Subanalysis of patients with signs of bleeding (n = 52) showed no difference between the two groups in the decrease in Hb levels or pRBC units transfused. Patients who received LMWH after 24 h had a higher incidence of symptomatic deep venous thrombosis and a longer hospital length of stay. Early initiation of thromboprophylaxis with LMWH in patients with pelvic fractures managed nonoperatively is safe and decreases the risk of symptomatic deep venous thrombosis.