Timing of Venous Thromboembolism Prophylaxis Initiation and Complications in Polytrauma Patients with High-Risk Bleeding Orthopedic Interventions: A Nationwide Analysis

医学 骨科手术 多发伤 围手术期 外科 回顾性队列研究 骨科手术
作者
Anna Kobzeva-Herzog,Sophia Foroushani,Daniel R. Counihan,Michaël Kain,Aaron Richman,Dane Scantling,Noelle Saillant,Sabrina E. Sanchez,Crisanto Torres
出处
期刊:The journal of trauma and acute care surgery [Lippincott Williams & Wilkins]
标识
DOI:10.1097/ta.0000000000004331
摘要

There are no clear recommendations for the perioperative timing and initiation of venous thromboembolism pharmacologic prophylaxis (VTEp) among polytrauma patients undergoing high-risk bleeding orthopedic operative intervention, leading to variations in VTEp administration. Our study examined the association between the timing of VTEp and VTE complications in polytrauma patients undergoing high-risk operative orthopedic interventions nationwide.A retrospective cohort study of trauma patients ≥18 years who underwent high-risk bleeding operative orthopedic interventions for pelvic, hip, and femur fractures within 24 hours of admission at American College of Surgeons (ACS) verified trauma centers using the 2019-2020 ACS-TQIP databank. We excluded patients with a competing risk of non-orthopedic surgical bleeding. We assessed operative orthopedic polytrauma patients who received VTEp within 12 hours of orthopedic surgical intervention compared to VTEp received beyond 12 hours of intervention. The primary outcome assessed was overall VTE events. Secondary outcomes were orthopedic reinterventions within 72 hours after primary orthopedic surgery, DVT, and PE rates.The study included 2,229 patients who underwent high-risk orthopedic operative intervention. The median time to VTEp initiation was 30 hours (IQR 18, 44). After adjustment for baseline patient, injury, and hospital characteristics, VTEp initiated more than 12 hours from primary orthopedic surgery was associated with increased odds of VTE (aOR 2.02; 95% CI 1.08-3.77). Earlier initiation of prophylaxis was not associated with an increased risk for surgical reintervention (HR 0.90; 95% CI 0.62-1.34).Administering VTEp within 24 hours of admission and within 12 hours of major orthopedic surgery involving the femur, pelvis, or hip demonstrated an associated decreased risk of in-hospital VTE without an accompanying elevated risk of bleeding-related orthopedic re-intervention. Clinicians should reconsider delays in initiating or withholding perioperative VTEp for stable polytrauma patients needing major orthopedic intervention.Level III, Therapeutic.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
小孙孙完成签到,获得积分10
刚刚
ZKJ发布了新的文献求助10
2秒前
2秒前
失眠紫青完成签到 ,获得积分10
4秒前
调皮从筠完成签到 ,获得积分10
4秒前
火星上眼睛完成签到,获得积分10
4秒前
隐形曼青应助学术虫采纳,获得10
5秒前
Water发布了新的文献求助10
5秒前
6秒前
6秒前
思源应助小孙孙采纳,获得10
7秒前
芋泥啵啵发布了新的文献求助10
7秒前
量子星尘发布了新的文献求助10
8秒前
顾矜应助cony采纳,获得10
9秒前
9秒前
蒋雪静发布了新的文献求助50
11秒前
11秒前
烂漫臻发布了新的文献求助10
11秒前
11秒前
YY发布了新的文献求助10
11秒前
宣仰完成签到,获得积分10
11秒前
12秒前
英姑应助靓丽芙蓉采纳,获得10
12秒前
我的文献呢应助lmh采纳,获得30
12秒前
尚尚下下完成签到,获得积分10
12秒前
xixixi发布了新的文献求助10
12秒前
gi发布了新的文献求助10
13秒前
快乐难敌完成签到,获得积分10
13秒前
13秒前
13秒前
东东发布了新的文献求助10
13秒前
邢巾完成签到 ,获得积分10
14秒前
快乐难敌发布了新的文献求助10
15秒前
15秒前
为你博弈发布了新的文献求助10
16秒前
郑盼秋发布了新的文献求助10
16秒前
murongbo发布了新的文献求助30
16秒前
16秒前
缓慢海亦发布了新的文献求助10
16秒前
酷酷筝发布了新的文献求助10
17秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Picture Books with Same-sex Parented Families: Unintentional Censorship 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
A Preliminary Study on Correlation Between Independent Components of Facial Thermal Images and Subjective Assessment of Chronic Stress 500
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 360
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3971125
求助须知:如何正确求助?哪些是违规求助? 3515824
关于积分的说明 11179811
捐赠科研通 3250971
什么是DOI,文献DOI怎么找? 1795610
邀请新用户注册赠送积分活动 875897
科研通“疑难数据库(出版商)”最低求助积分说明 805207