Breaking Down the Evidence: A Multicenter Analysis of Venous Thromboembolism Among Trauma Patients with Lower Extremity Fractures.

OBJECTIVES

To determine whether chemoprophylaxis initiation within 24 hours reduces venous thromboembolism (VTE) risk among trauma patients with lower extremity long bone fractures.

DESIGN

This was a retrospective cohort study.

SETTING

Seventeen Level I trauma centers as a part of the Consortium of Leaders in the Study of Traumatic Thromboembolism study group.

PATIENT SELECTION CRITERIA: Patients aged 18-40 years with a diagnosis of lower extremity long bone fracture between January 1, 2018, and December 31, 2020, were included.

OUTCOME MEASURES AND COMPARISONS: Primary outcome was VTE during admission. Patients were compared based on VTE chemoprophylaxis initiation within 24 hours (early prophylaxis, E-PROPH) versus not (late or no prophylaxis, L-PROPH) using inverse probability weighted Cox survival analysis.

RESULTS

In total, 120 (5.3%) among 2264 patients with lower extremity fractures developed VTE. 57.5% received E-PROPH and 42.5% received L-PROPH. The E-PROPH group had fewer patients with an injury severity score ≥16 (30.3% vs. 52.4%, P < 0.001) and a lower proportion of associated head injury (8.1% vs. 26.7%, P < 0.001). VTE incidence was significantly higher in the L-PROPH group than in the E-PROPH group (8.6% vs. 2.8%, P < 0.001). In the adjusted model, E-PROPH was independently associated with nearly a half reduction in VTE incidence (hazard ratio: 0.54, 95% confidence interval, 0.34-0.85). There was no significant difference in the adjusted bleeding complication model (aOR 1.84; 95% confidence interval, 0.75-4.57).

CONCLUSION

VTE chemoprophylaxis within the first 24 hours of admission was associated with a marked reduction in VTE incidence among patients with traumatic lower extremity long bone fractures without increase in bleeding risks.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.