Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures
Retrospective cohort study. To examine the impact of early (
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2015-03, Vol.40 (5), p.299-304 |
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| container_title | Spine (Philadelphia, Pa. 1976) |
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| creator | Kim, Dennis Yong Kobayashi, Leslie Chang, David Fortlage, Dale Coimbra, Raul |
| description | Retrospective cohort study.
To examine the impact of early ( |
| doi_str_mv | 10.1097/BRS.0000000000000754 |
| format | Article |
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To examine the impact of early (<48 hr) versus late (≥48 hr) initiation of pharmacological venous thromboembolism (VTE) prophylaxis on outcomes and complications among trauma patients undergoing operative fixation of spine fractures.
VTE complications are associated with poor outcomes after trauma. Although pharmacological prophylaxis decreases the risk of VTE after trauma, concerns regarding bleeding-related complications among certain patient subgroups persist. At present, there are limited data regarding the safety of early VTE prophylaxis in trauma patients undergoing operative fixation of spine fractures.
We performed a 5-year retrospective analysis of our level 1 trauma center registry to identify consecutive patients undergoing operative fixation of spine fractures. Demographics, injury patterns and severity, details of operative procedures, timing of administration of VTE prophylaxis, and outcomes were analyzed. Patients receiving early VTE prophylaxis were compared with patients receiving late VTE prophylaxis. Multivariate analysis was performed to identify independent predictors of VTE.
Of 1432 patients with spine fractures, 206 patients (14.4%) underwent operative fixation. Forty-eight (23.3%) received early VTE prophylaxis and 158 (76.7%) received late VTE prophylaxis. No patient developed an epidural hematoma or postoperative bleeding necessitating intervention in either group. Thirteen patients (6.2%) developed VTE, of which 12 occurred in the late VTE prophylaxis group. Age 45 years or more (odds ratio = 5.12, 95% confidence interval = 1.01-25.94, P = 0.048) and traumatic brain injury (odds ratio = 6.94, 95% confidence interval = 1.19-40.35, P = 0.031) were independently associated with an increased risk for VTE.
Pharmacological VTE prophylaxis initiated within 48 hours of operative fixation of traumatic spine fractures seems to be safe and is not associated with an increased risk of bleeding or neurological complications. Large, multicenter prospective studies are required to further define the efficacy and safety of an early pharmacological VTE prophylaxis strategy in this at-risk patient population.
3.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0000000000000754</identifier><identifier>PMID: 25901977</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Female ; Fracture Fixation, Internal - adverse effects ; Humans ; Male ; Middle Aged ; Post-Exposure Prophylaxis - methods ; Retrospective Studies ; Spinal Fractures - diagnosis ; Spinal Fractures - drug therapy ; Spinal Fractures - surgery ; Thrombolytic Therapy - methods ; Trauma Centers ; Treatment Outcome ; Venous Thromboembolism - drug therapy ; Venous Thromboembolism - prevention & control ; Young Adult</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2015-03, Vol.40 (5), p.299-304</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c307t-b8709ee6412a9d3ade63dc15a9d075973e39b933858ce592c37aa2201ced740d3</citedby><cites>FETCH-LOGICAL-c307t-b8709ee6412a9d3ade63dc15a9d075973e39b933858ce592c37aa2201ced740d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25901977$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Dennis Yong</creatorcontrib><creatorcontrib>Kobayashi, Leslie</creatorcontrib><creatorcontrib>Chang, David</creatorcontrib><creatorcontrib>Fortlage, Dale</creatorcontrib><creatorcontrib>Coimbra, Raul</creatorcontrib><title>Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>Retrospective cohort study.
To examine the impact of early (<48 hr) versus late (≥48 hr) initiation of pharmacological venous thromboembolism (VTE) prophylaxis on outcomes and complications among trauma patients undergoing operative fixation of spine fractures.
VTE complications are associated with poor outcomes after trauma. Although pharmacological prophylaxis decreases the risk of VTE after trauma, concerns regarding bleeding-related complications among certain patient subgroups persist. At present, there are limited data regarding the safety of early VTE prophylaxis in trauma patients undergoing operative fixation of spine fractures.
We performed a 5-year retrospective analysis of our level 1 trauma center registry to identify consecutive patients undergoing operative fixation of spine fractures. Demographics, injury patterns and severity, details of operative procedures, timing of administration of VTE prophylaxis, and outcomes were analyzed. Patients receiving early VTE prophylaxis were compared with patients receiving late VTE prophylaxis. Multivariate analysis was performed to identify independent predictors of VTE.
Of 1432 patients with spine fractures, 206 patients (14.4%) underwent operative fixation. Forty-eight (23.3%) received early VTE prophylaxis and 158 (76.7%) received late VTE prophylaxis. No patient developed an epidural hematoma or postoperative bleeding necessitating intervention in either group. Thirteen patients (6.2%) developed VTE, of which 12 occurred in the late VTE prophylaxis group. Age 45 years or more (odds ratio = 5.12, 95% confidence interval = 1.01-25.94, P = 0.048) and traumatic brain injury (odds ratio = 6.94, 95% confidence interval = 1.19-40.35, P = 0.031) were independently associated with an increased risk for VTE.
Pharmacological VTE prophylaxis initiated within 48 hours of operative fixation of traumatic spine fractures seems to be safe and is not associated with an increased risk of bleeding or neurological complications. Large, multicenter prospective studies are required to further define the efficacy and safety of an early pharmacological VTE prophylaxis strategy in this at-risk patient population.
3.</description><subject>Adult</subject><subject>Female</subject><subject>Fracture Fixation, Internal - adverse effects</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Post-Exposure Prophylaxis - methods</subject><subject>Retrospective Studies</subject><subject>Spinal Fractures - diagnosis</subject><subject>Spinal Fractures - drug therapy</subject><subject>Spinal Fractures - surgery</subject><subject>Thrombolytic Therapy - methods</subject><subject>Trauma Centers</subject><subject>Treatment Outcome</subject><subject>Venous Thromboembolism - drug therapy</subject><subject>Venous Thromboembolism - prevention & control</subject><subject>Young Adult</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUNtOwzAMjRCIjcEfIJRHXjqSpmmaR5jGRZqExOW5clOXFbVNSdpp-3uCGAhh2bItH98OIeeczTnT6urm6XnO_oqSyQGZchlnEedSH5IpE2kcxYlIJ-TE-_eASQXXx2QSS824VmpKNktwzY72a3AtGNvYt9pAQzfY2dHTYe1sW1gM1tS-pb2z_XrXwLb2NKiHCilUAzpqe3Qw1BukVb0Nge2orejgYGxDZqjv6y7UHJhhdOhPyVEFjcezvZ-R19vly-I-Wj3ePSyuV5ERTA1RkSmmEdOEx6BLASWmojRchiS8q5VAoQstRCYzg1LHRiiAOGbcYKkSVooZufyeGy7_GNEPeVt7g00DHYYHc54qmSkpVRagyTfUOOu9wyrvXd2C2-Wc5V-M54Hx_D_joe1iv2EsWix_m34oFp8EIX7h</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Kim, Dennis Yong</creator><creator>Kobayashi, Leslie</creator><creator>Chang, David</creator><creator>Fortlage, Dale</creator><creator>Coimbra, Raul</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150301</creationdate><title>Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures</title><author>Kim, Dennis Yong ; Kobayashi, Leslie ; Chang, David ; Fortlage, Dale ; Coimbra, Raul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c307t-b8709ee6412a9d3ade63dc15a9d075973e39b933858ce592c37aa2201ced740d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Female</topic><topic>Fracture Fixation, Internal - adverse effects</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Post-Exposure Prophylaxis - methods</topic><topic>Retrospective Studies</topic><topic>Spinal Fractures - diagnosis</topic><topic>Spinal Fractures - drug therapy</topic><topic>Spinal Fractures - surgery</topic><topic>Thrombolytic Therapy - methods</topic><topic>Trauma Centers</topic><topic>Treatment Outcome</topic><topic>Venous Thromboembolism - drug therapy</topic><topic>Venous Thromboembolism - prevention & control</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Dennis Yong</creatorcontrib><creatorcontrib>Kobayashi, Leslie</creatorcontrib><creatorcontrib>Chang, David</creatorcontrib><creatorcontrib>Fortlage, Dale</creatorcontrib><creatorcontrib>Coimbra, Raul</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Dennis Yong</au><au>Kobayashi, Leslie</au><au>Chang, David</au><au>Fortlage, Dale</au><au>Coimbra, Raul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>40</volume><issue>5</issue><spage>299</spage><epage>304</epage><pages>299-304</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><abstract>Retrospective cohort study.
To examine the impact of early (<48 hr) versus late (≥48 hr) initiation of pharmacological venous thromboembolism (VTE) prophylaxis on outcomes and complications among trauma patients undergoing operative fixation of spine fractures.
VTE complications are associated with poor outcomes after trauma. Although pharmacological prophylaxis decreases the risk of VTE after trauma, concerns regarding bleeding-related complications among certain patient subgroups persist. At present, there are limited data regarding the safety of early VTE prophylaxis in trauma patients undergoing operative fixation of spine fractures.
We performed a 5-year retrospective analysis of our level 1 trauma center registry to identify consecutive patients undergoing operative fixation of spine fractures. Demographics, injury patterns and severity, details of operative procedures, timing of administration of VTE prophylaxis, and outcomes were analyzed. Patients receiving early VTE prophylaxis were compared with patients receiving late VTE prophylaxis. Multivariate analysis was performed to identify independent predictors of VTE.
Of 1432 patients with spine fractures, 206 patients (14.4%) underwent operative fixation. Forty-eight (23.3%) received early VTE prophylaxis and 158 (76.7%) received late VTE prophylaxis. No patient developed an epidural hematoma or postoperative bleeding necessitating intervention in either group. Thirteen patients (6.2%) developed VTE, of which 12 occurred in the late VTE prophylaxis group. Age 45 years or more (odds ratio = 5.12, 95% confidence interval = 1.01-25.94, P = 0.048) and traumatic brain injury (odds ratio = 6.94, 95% confidence interval = 1.19-40.35, P = 0.031) were independently associated with an increased risk for VTE.
Pharmacological VTE prophylaxis initiated within 48 hours of operative fixation of traumatic spine fractures seems to be safe and is not associated with an increased risk of bleeding or neurological complications. Large, multicenter prospective studies are required to further define the efficacy and safety of an early pharmacological VTE prophylaxis strategy in this at-risk patient population.
3.</abstract><cop>United States</cop><pmid>25901977</pmid><doi>10.1097/BRS.0000000000000754</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Female Fracture Fixation, Internal - adverse effects Humans Male Middle Aged Post-Exposure Prophylaxis - methods Retrospective Studies Spinal Fractures - diagnosis Spinal Fractures - drug therapy Spinal Fractures - surgery Thrombolytic Therapy - methods Trauma Centers Treatment Outcome Venous Thromboembolism - drug therapy Venous Thromboembolism - prevention & control Young Adult |
| title | Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures |
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