Timing and choice of systemic anticoagulation in the setting of extremity arterial injury repair

Purpose The role of perioperative anticoagulation in the setting of peripheral arterial injury remains unclear. We hypothesized that early initiation of anticoagulation is associated with a reduced amputation rate without increasing bleeding complications. Methods Using the 2016–2019 ACS-TQIP databa...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2023-02, Vol.49 (1), p.473-485
Main Authors: Argandykov, Dias, Proaño-Zamudio, Jefferson A., Dorken-Gallastegi, Ander, Gebran, Anthony, Renne, Angela M., Paranjape, Charudutt N., King, David R., Kaafarani, Haytham M. A., Velmahos, George C., Hwabejire, John O.
Format: Article
Language:English
Subjects:
Adult
Anticoagulants
Anticoagulants - therapeutic use
Critical Care Medicine
Disease prevention
Emergency medical care
Emergency Medicine
Extremities
Female
Hemorrhage - complications
Heparin - therapeutic use
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Injuries
Intensive
Male
Medicine
Medicine & Public Health
Original Article
Sports Medicine
Surgery
Surgical Orthopedics
Traumatic Surgery
Vascular surgery
Vascular System Injuries - complications
Venous Thromboembolism - etiology
Venous Thromboembolism - prevention & control
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Summary:Purpose The role of perioperative anticoagulation in the setting of peripheral arterial injury remains unclear. We hypothesized that early initiation of anticoagulation is associated with a reduced amputation rate without increasing bleeding complications. Methods Using the 2016–2019 ACS-TQIP database, adult patients with upper and lower extremity vascular injuries who underwent open arterial repair and received anticoagulation were included. Patients were divided into two groups: (1) early venous thromboembolism prophylaxis (≤ 24 h) and (2) late prophylaxis (> 24 h) following arterial repair. The primary outcomes were the rates of limb amputation and bleeding complications. Multivariable logistic regression was used to estimate the impact of timing and type of anticoagulation on the rates of limb amputation and bleeding complications. Results 4379 patients were included, and 83.9% were males. 68.1% of patients received early anticoagulation, whereas 31.9% received late thromboprophylaxis. Low-molecular-weight heparin (LMWH) was used in 62.0% of patients, and unfractionated heparin (UFH) was administered in 34.3% of patients. Multivariable analysis showed that late initiation of thromboprophylaxis (OR = 1.69 [1.16–2.45], p  = 0.006) and use of UFH (OR = 2.61 [1.80–3.79], p  
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-022-02092-w