BACKGROUND: Nonoperative management (NOM) has become more common in hemodynamically stable patients with high-grade blunt splenic injury. However, there are no widely accepted guidelines for an optimal and safe timeframe for the initiation of venous thromboembolism (VTE) prophylaxis. The purpose of this study was to explore the association between the timing of VTE prophylaxis initiation and NOM failure rate in isolated high-grade blunt splenic injury. METHODS: We utilized the American College of Surgeons Trauma Quality Improvement Program database (2013-2014) to identify adult patients who underwent NOM for isolated high-grade blunt splenic injuries (grades 3-5). The incidence of NOM failure after the initiation of VTE prophylaxis was compared between two groups: VTE prophylaxis <48 h after admission (early prophylaxis group), and ≥48 h (late prophylaxis group). RESULTS: A total of 816 patients met the inclusion criteria. Of those, VTE prophylaxis was not administered in 525 patients (64.3%), whereas VTE prophylaxis was given <48 h and ≥48 h after admission in 144 and 147 patients, respectively. There was no significant difference in the NOM failure rate after the initiation of VTE prophylaxis between the early and late prophylaxis groups (3.5% versus 3.4%, P = 1.00). In the multiple logistic regression analysis, early initiation of VTE prophylaxis was not significantly associated with NOM failure (OR: 1.32, 95% CI 0.35-4.93, P = 0.68). CONCLUSIONS: The results of our study suggest that early initiation of VTE prophylaxis (<48 h) does not increase the risk of NOM failure in patients with isolated high-grade blunt splenic injury.
BACKGROUND: Nonoperative management (NOM) has become more common in hemodynamically stable patients with high-grade blunt splenic injury. However, there are no widely accepted guidelines for an optimal and safe timeframe for the initiation of venous thromboembolism (VTE) prophylaxis. The purpose of this study was to explore the association between the timing of VTE prophylaxis initiation and NOM failure rate in isolated high-grade blunt splenic injury. METHODS: We utilized the American College of Surgeons Trauma Quality Improvement Program database (2013-2014) to identify adult patients who underwent NOM for isolated high-grade blunt splenic injuries (grades 3-5). The incidence of NOM failure after the initiation of VTE prophylaxis was compared between two groups: VTE prophylaxis <48 h after admission (early prophylaxis group), and ≥48 h (late prophylaxis group). RESULTS: A total of 816 patients met the inclusion criteria. Of those, VTE prophylaxis was not administered in 525 patients (64.3%), whereas VTE prophylaxis was given <48 h and ≥48 h after admission in 144 and 147 patients, respectively. There was no significant difference in the NOM failure rate after the initiation of VTE prophylaxis between the early and late prophylaxis groups (3.5% versus 3.4%, P = 1.00). In the multiple logistic regression analysis, early initiation of VTE prophylaxis was not significantly associated with NOM failure (OR: 1.32, 95% CI 0.35-4.93, P = 0.68). CONCLUSIONS: The results of our study suggest that early initiation of VTE prophylaxis (<48 h) does not increase the risk of NOM failure in patients with isolated high-grade blunt splenic injury.
Authors: Mauro Podda; Belinda De Simone; Marco Ceresoli; Francesco Virdis; Francesco Favi; Johannes Wiik Larsen; Federico Coccolini; Massimo Sartelli; Nikolaos Pararas; Solomon Gurmu Beka; Luigi Bonavina; Raffaele Bova; Adolfo Pisanu; Fikri Abu-Zidan; Zsolt Balogh; Osvaldo Chiara; Imtiaz Wani; Philip Stahel; Salomone Di Saverio; Thomas Scalea; Kjetil Soreide; Boris Sakakushev; Francesco Amico; Costanza Martino; Andreas Hecker; Nicola de'Angelis; Mircea Chirica; Joseph Galante; Andrew Kirkpatrick; Emmanouil Pikoulis; Yoram Kluger; Denis Bensard; Luca Ansaloni; Gustavo Fraga; Ian Civil; Giovanni Domenico Tebala; Isidoro Di Carlo; Yunfeng Cui; Raul Coimbra; Vanni Agnoletti; Ibrahima Sall; Edward Tan; Edoardo Picetti; Andrey Litvin; Dimitrios Damaskos; Kenji Inaba; Jeffrey Leung; Ronald Maier; Walt Biffl; Ari Leppaniemi; Ernest Moore; Kurinchi Gurusamy; Fausto Catena Journal: World J Emerg Surg Date: 2022-10-12 Impact factor: 8.165