TIMING OF VENOUS THROMBOPROPHYLAXIS IN ISOLATED SEVERE PELVIC FRACTURE: EFFECT ON MORTALITY AND OUTCOMES

Publication date: Available online 14 February 2019

Source: Injury

Author(s): Elizabeth Benjamin, Alberto Aiolfi, Gustavo Recinos, Kenji Inaba, Demetrios Demetriades

Abstract

Introduction

Optimal timing of pharmacological thromboprophylaxis (VTEp) in patients with severe pelvic fractures remains unclear. The high risk of venous thromboembolic (VTE) complications after severe pelvic fractures supports early VTEp however concern for fracture-associated hemorrhage can delay initiation. Patients with pelvic fractures also frequently have additional injuries that complicate the interpretation of the VTEp safety profiles. To minimize this problem, the study included only patients with isolated severe pelvic fractures.

Materials and Methods

The Trauma Quality Improvement Program was used to collect patients with blunt severe pelvic fractures (AIS > 3) who received VTEp with unfractionated heparin (UH) or low-molecular-weight heparin (LMWH). Patients with head, chest, spine, and abdominal injuries AIS > 3, or those with angio or operative intervention prior to VTEp were excluded. The study population was stratified according to timing of VTEp, early (<48 hrs) and late (>48 hrs). Outcomes included in-hospital mortality and VTE.

Results

2,752 patients were included in the study. Overall, 2,007 patients (72.9%) received early VTEp, while 745 (27.1%) received late VTEp. LMWH was administered in 2,349 (85.4%) and UH in 403 (14.6%).

Late VTEp was associated with significantly higher incidence of VTE (4.3% vs. 2.2%, p = 0.004). Logistic regression identified late VTEp as an independent risk factor for VTE (OR 1.93, p = 0.009) and mortality (OR 4.03, p = 0.006). LMWH was an independent factor protective for both VTE and mortality (OR 0.373, p < 0.001, OR 0.266, p = 0.009, respectively).

Conclusion

In isolated severe pelvic fractures, early VTEp is independently associated with improved survival and fewer VTE. LMWH may be preferred over UH for this purpose.

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