M. Khan1, J. Con1, F. Jehan1, R. Latifi1 1Westchester Medical Center,Surgery,Valhalla, NY, USA
Background: Pelvic fractures have been identified as a risk factor for venous thromboembolic (VTE) complications. Recent literature shows the superiority of novel oral anticoagulants (NOACs) over low molecular weight heparin (LMWH) for thromboprophylaxis in orthopedic patients. The aim of our study was to evaluate the impact of NOACs vs. LMWH on outcomes in patients with operative pelvic fractures.
Methods: We performed a 2-year (2015-16) analysis of the ACS-TQIP database. We included all adult patients with isolated blunt pelvic fractures who were managed operatively and received post-operative thromboprophylaxis with either LMWH or NOACs (Factor Xa inhibitor and direct thrombin inhibitor). Patients were stratified into two groups based on the type of thromboprophylactic agent (NOACs vs. LMWH) and were matched in a 1:2 ratio for demographics, admission vitals, injury parameters, hospital stay, facility, and timing of initiation of thromboprophylaxis. Primary outcomes were rate of DVT and/or PE. Secondary outcomes were pRBC transfusions, and intervention for hemorrhage control after initiation of thromboprophylaxis.
Results: We analyzed 11,219 patients with pelvic fractures. A total of 3,529 patients with isolated pelvic fractures were included of which 708 patients were matched (NOACs: 236; LMWH: 472). Mean age was 61±12 and median ISS was 12[10-16]. Matched groups were similar in demographics, vitals and injury parameters, hospital stay, and timing of initiation of thromboprophylaxis. Overall 5.8% of patients had DVT, and 1.8% PE%. Patients who received NOACs were less likely to develop DVT (2.9% vs. 7.2%, p=0.01) compared to LMWH. There was no difference in PE (1.6% vs. 1.9%, p=0.28) between the two groups. Similarly there was no difference in post prophylaxis blood products transfusion, and post-prophylaxis intervention for hemorrhage control(Table 1.).
Conclusion: In patients with operative pelvic fracture, thromboprophylaxis with novel oral anticoagulant is associated with lower rate of DVT. There was no association between type of thromboprophylactic agent with PE. Further prospective clinical trials should evaluate the role of NOACs for thromboprophylaxis in high-risk trauma patients.
