M. N. Khan1, M. Zeeshan1, E. Zakaria1, N. Kulvatunyou1, T. O’Keeffe1, L. Gries1, A. Tang1, A. Jain1, B. Joseph1 1University Of Arizona,Tucson, AZ, USA
Introduction:
Patients with spinal trauma have the highest risk of a venous thromboembolism (VTE) despite pharmacological thromboprophylaxis. Oral Xa Inhibitors (XaInh) are recommended after major orthopedic operation, however, its role in spine trauma is not well-defined. The aim of our study was therefore, to assess the impact of XaInh on VTE in spinal trauma patients managed non-operatively.
Methods:
A 2-year (2013-2014) review of the TQIP database for all patients with an isolated spine-trauma (spine-abbreviated injury scale [S-AIS] ≥2 and other body region AIS<4) who were managed non-operatively and received prophylactic anticoagulation with either Low molecular weight heparin (LMWH) or XaInh. Patients were divided into two groups based on the thromboprophylactic agent received: LMWH and XaInh, and matched in a 1:2 ratio using propensity score matching for demographics, admission vitals, injury severity, timing of intitation of thromboprophylaxis and level of spine-injury. Outcomes were incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE), return to the operating room (OR), and mortality.
Results:
We analyzed a total of 22260 patients, of which 603 patients (LMWH: 402, XaInh: 201) were matched. Matched groups were similar in age (p=0.34), gender (p =0.39), systolic blood pressure (p=0.46), heart rate (p=0.53), injury severity score (p=0.44), and S-AIS (p=0.43). Patients who received XaInh were less likely to develop a DVT (1% vs. 4.9%, p=0.01) compared to those who received LMWH. Furthermore, there was no difference in PE rates (p=0.55), return to the operating room (p=0.11), mortality rate (p=0.29), hospital (p=0.34) and intensive care unit length of stay (p=0.24) among two groups.
Conclusion:
Oral Xa inhibitors were more effective as prophylactic pharmacological agent for the prevention of deep venous thrombosis in patients with non-operative spinal trauma compared to low molecular weight heparin. The two drugs had similar safety profile. Further prospective trials should be performed to make specific recommendations.