F. Jehan1, K. Ibraheem1, A. Azim1, A. Tang1, T. O’Keeffe1, N. Kulvatunyou1, L. Gries1, G. Vercruysse1, R. Friese1, B. Joseph1 1University Of Arizona,Trauma,critical Care, Burn And Emergency Surgery/Department Of Surgery,Tucson, AZ, USA
Introduction:
Early initiation of thromboprophylaxis is highly desired in patients with pelvic fractures but it is often delayed due to fears of re-bleeding and hemorrhage. The aim of our study was to assess the safety profile of early initiation of venous thromboprophylaxis in patients with pelvic trauma.
Methods:
Three year (2010-2012) retrospective study of trauma patients with pelvic fractures presenting at single level-I trauma center was performed. Patients who received thromboprophylaxis with low molecular weight heparin (LMWH) during their hospital stay were included. Patients were stratified in two groups based on timing of initiation of prophylaxis; early (initiation within first 24 hours) and late (initiation after 24 hours) initiation. Signs of bleeding or hemorrhage were defined as presence of pelvic hematoma, free fluid, or blush on CT scan. Decrease in hemoglobin (Hb) was defined as difference between admission Hb level and lowest post-prophylaxis Hb level. Our primary outcome measures were decrease in Hb levels, pRBC units transfused, and need for hemorrhage control (operative or angioembolization) after initiation of prophylaxis. Secondary outcome measures were hospital and ICU length of stay. Multivariate regression analysis was performed.
Results:
255 patients were included (158 in early and 97 in late group). Mean±SD age was 48.2±23.3 years, 50.6% were male, and mean±SD number of pRBC units was 0.62±1.59. After adjusting for confounders, there was no difference in the decrease in Hb levels (b= 0.087, 95% [CI]=[-0.253 – 1.025], p=0.23) or pRBC units transfused (b= -0.005, 95% [CI]= [-0.366 – 0.364]; p=0.75) between the two groups. Only one patient required hemorrhage control after initiation of thromboprophylaxis and belonged to the late group. There was no difference in the hospital LOS (b=0.120, 95% [CI]= -0.165 – 4.929; p=0.67). ICU length of stay was significantly shorter in early prophylaxis group (b= 0.206, 95% [CI]= 0.206 – 4.762; p=0.03).
On sub-analysis of patients with signs of bleeding or hemorrhage (n=52), there was no difference in decrease in Hb levels (b= 0.131, 95% [CI]= -1.411 – 2.586; p=0.55) or pRBC units transfused (b= -0.007, 95% [CI]= -1.588 – 1.518; p=0.96) between the two groups
Conclusion:
Our study shows no difference in pRBC transfusion requirements, drop in hemoglobin levels, or need for hemorrhage control between early and late initiation of thromboprophylaxis. We conclude that fear of hemorrhage with early thromboprophylaxis is not substantiated in patients with pelvic fractures