Annals of surgery · 2025
Timing Is Everything: Early Initiation of VTE Prophylaxis Following Major Trauma Is Effective and Safe.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Kerwin Andrew J, Byerly Saskya, Filiberto Dina M, Lenart Emily K, Croce Martin A, Moore Ernest E, Knudson Mary Margaret, CLOTT Study Group
Аннотация
OBJECTIVE: To examine the efficacy and safety of the initiation of pharmacologic venous thromboembolism (VTE) prophylaxis within 24 hours of admission for major trauma patients at risk for VTE.
BACKGROUND: Pharmacologic VTE prophylaxis following major trauma is essential, but there is a fear of bleeding complications. The safety of initiating treatment within 24 hours of admission has not been established.
METHODS: We examined the efficacy and safety of early initiation of pharmacologic VTE prophylaxis. Patients were stratified by time to initiation [≤24 h (EARLY) or >24 h (LATE)] and compared. VTE, VTE prophylaxis agents, and bleeding complications secondary to VTE prophylaxis were analyzed. A generalized linear mixed model (GLMM) was performed to identify predictors of VTE.
RESULTS: There were 3369 EARLY group patients and 3200 LATE group patients. More patients in the LATE group developed VTE (7.8% vs. 2.8%; P <0.001). Among 345 patients with VTE, deep venous thrombosis (DVT) alone [181 (72%) vs. 61 (65%)], pulmonary embolism (PE) alone [46 (18%) vs. 22 (23%)] and both DVT and PE [24 (10%) vs. 11 (12%)] were present in the LATE compared with the EARLY group. The LATE group had a higher incidence of increased or new intracranial hemorrhage following prophylaxis initiation (0.5% vs. 0.2%; P =0.009) and higher mortality (1.8% vs. 0.6%; P <0.001). GLMM demonstrated that EARLY VTE prophylaxis was associated with a lower risk of VTE [odds ratio (OR): 0.58; 95% CI: 0.44-0.78; P <0.001], after controlling for covariates.
CONCLUSIONS: Initiating VTE prophylaxis within the first 24 hours after admission resulted in a 42% reduction of the risk of VTE without increased risk of bleeding and should be regarded as the standard of care, even in traumatic brain injury patients.
BACKGROUND: Pharmacologic VTE prophylaxis following major trauma is essential, but there is a fear of bleeding complications. The safety of initiating treatment within 24 hours of admission has not been established.
METHODS: We examined the efficacy and safety of early initiation of pharmacologic VTE prophylaxis. Patients were stratified by time to initiation [≤24 h (EARLY) or >24 h (LATE)] and compared. VTE, VTE prophylaxis agents, and bleeding complications secondary to VTE prophylaxis were analyzed. A generalized linear mixed model (GLMM) was performed to identify predictors of VTE.
RESULTS: There were 3369 EARLY group patients and 3200 LATE group patients. More patients in the LATE group developed VTE (7.8% vs. 2.8%; P <0.001). Among 345 patients with VTE, deep venous thrombosis (DVT) alone [181 (72%) vs. 61 (65%)], pulmonary embolism (PE) alone [46 (18%) vs. 22 (23%)] and both DVT and PE [24 (10%) vs. 11 (12%)] were present in the LATE compared with the EARLY group. The LATE group had a higher incidence of increased or new intracranial hemorrhage following prophylaxis initiation (0.5% vs. 0.2%; P =0.009) and higher mortality (1.8% vs. 0.6%; P <0.001). GLMM demonstrated that EARLY VTE prophylaxis was associated with a lower risk of VTE [odds ratio (OR): 0.58; 95% CI: 0.44-0.78; P <0.001], after controlling for covariates.
CONCLUSIONS: Initiating VTE prophylaxis within the first 24 hours after admission resulted in a 42% reduction of the risk of VTE without increased risk of bleeding and should be regarded as the standard of care, even in traumatic brain injury patients.