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Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review



The need to prevent venous thromboembolism (VTE) following blunt solid organ injury must be balanced against the concern for exacerbation of hemorrhage. The optimal timing for initiation of VTE chemoprophylaxis is not known. The objective was to determine the safety and efficacy of early (≤ 48 h) VTE chemoprophylaxis initiation following blunt solid organ injury.


An electronic search was performed of medical libraries for English language studies on timing of VTE chemoprophylaxis initiation following blunt solid organ injury published from inception to April 2020. Included studies compared early (≤ 48 h) versus late (> 48 h) initiation of VTE chemoprophylaxis in adults with blunt splenic, liver, and/or kidney injury. Estimates were pooled using random-effects meta-analysis. Odds ratios were utilized to quantify differences in failure of nonoperative management, need for blood transfusion and rates of VTE.


The search identified 2,111 studies. Of these, ten studies comprising 14,675 patients were included. All studies were non-randomized and only one was prospective. The overall odds of failure of nonoperative management were no different between early and late groups, OR 1.09 (95%CI 0.92–1.29). Similarly, there was no difference in the need for blood transfusion either during overall hospital stay, OR 0.91 (95%CI 0.70–1.18), or post prophylaxis initiation, OR 1.23 (95%CI 0.55–2.73). There were significantly lower odds of VTE when patients received early VTE chemoprophylaxis, OR 0.51 (95%CI 0.33–0.81).


Patients undergoing nonoperative management for blunt solid organ injury can be safely and effectively prescribed early VTE chemoprophylaxis. This results in significantly lower VTE rates without demonstrable harm.

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  1. 1.

    Mammen EF. Pathogenesis of Venous Thrombosis. Am Coll Chest Phys. 1992;102:640S-S644.

    CAS  Google Scholar 

  2. 2.

    Nathens AB, McMurray MK, Cuschieri J, Durr EA, Moore EE, Bankey PE, Freeman B, Harbrecht BG, Johnson JL, Minei JP, McKinley BA, Moore FA, Shapiro MB, West MA, Tompkins RG, Maier RV. The practice of venous thromboembolism prophylaxis in the major trauma patient. J Trauma. 2007;62(3):557–62.

    PubMed  Google Scholar 

  3. 3.

    Schellenberg M, Inaba K, Biswas S, Heindel P, Benjamin E, Strumwasser A, et al. When is it safe to start VTE prophylaxis after blunt solid organ injury? a prospective study from a level I trauma center. World J Surg. 2019;43:2797–803.

    Article  Google Scholar 

  4. 4.

    Alejandro KV, Acosta JA, Rodríguez PA. Bleeding manifestations after early use of low-molecular-weight heparins in blunt splenic injuries. Am Surg. 2003;69:1006–9.

    PubMed  Google Scholar 

  5. 5.

    Eberle BM, Schnüriger B, Inaba K, Cestero R, Kobayashi L, Barmparas G, et al. Thromboembolic prophylaxis with low-molecular-weight heparin in patients with blunt solid abdominal organ injuries undergoing nonoperative management: current practice and outcomes. J Trauma. 2011;70:141–6.

    CAS  PubMed  Google Scholar 

  6. 6.

    Joseph B, Pandit V, Harrison C, Lubin D, Kulvatunyou N, Zangbar B, et al. Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: Is it safe? Am J Surg. 2015;209:194–8.

    Article  Google Scholar 

  7. 7.

    Khatsilouskaya T, Haltmeier T, Cathomas M, Eberle B, Candinas D, Schnüriger B. Thromboembolic prophylaxis with heparin in patients with blunt solid organ injuries undergoing non-operative treatment. World J Surg. 2017;41:1193–200.

    Article  Google Scholar 

  8. 8.

    Kwok AM, Davis JW, Dirks RC, Wolfe MM, Kaups KL. Time is now: venous thromboembolism prophylaxis in blunt splenic injury. Am J Surg. 2016;212:1231–6.

    Article  Google Scholar 

  9. 9.

    Lin B, Matsushima K, De Leon L, Piccinini A, Recinos G, Love B, et al. Early venous thromboembolism prophylaxis for isolated high-grade blunt splenic injury. J Surg Res. 2019;243:340–5.

    Article  Google Scholar 

  10. 10.

    Murphy PB, Sothilingam N, Stewart TC, Batey B, Moffat B, Gray DK, et al. Very early initiation of chemical venous thromboembolism prophylaxis after blunt solid organ injury is safe. Can J Surg. 2016;59:118–22.

    Article  Google Scholar 

  11. 11.

    Rostas JW, Manley J, Gonzalez RP, Brevard SB, Ahmed N, Frotan MA, et al. The safety of low molecular-weight heparin after blunt liver and spleen injuries. Am J Surg. 2015;210:31–4.

    Article  Google Scholar 

  12. 12.

    Skarupa D, Hanna K, Zeeshan M, Madbak F, Hamidi M, Haddadin Z, et al. Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision? J Trauma. 2019;87:1104–12.

    CAS  Article  Google Scholar 

  13. 13.

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;21(339):b2700.

    Article  Google Scholar 

  14. 14.

    Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. [cited 2015 Nov 29]. Available from:

  15. 15.

    Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  Google Scholar 

  16. 16.

    Chapman B, Moore E, Barnett C, Stovall R, Biffl W, Burley C, et al. Hypercoagulability following blunt solid abdominal organ injury: when to initiate anticoagulation. Am J Surg. 2013;206:917–23.

    Article  Google Scholar 

  17. 17.

    Vogt K, Mahiri K, Murphy P, Parry N, Gray D, Moffat B, et al. The timing of initiation of venous thromboembolism prophylaxis after traumatic solid organ injury: a national survey of practice. Can J Surg. 2016;59:S30.

    Google Scholar 

  18. 18.

    Zarzaur BL, Kozar RA, Fabian TC, Coimbra R. A survey of american association for the surgery of trauma member practices in the management of blunt splenic injury. J Trauma. 2011;70:1026–31.

    PubMed  Google Scholar 

  19. 19.

    Baltatzis M, Low R, Stathakis P, Sheen AJ, Siriwardena AK, Jamdar S. Efficacy and safety of pharmacological venous thromboembolism prophylaxis following liver resection: a systematic review and meta-analysis. HPB. 2017;19:289–96.

    Article  Google Scholar 

  20. 20.

    Ho KM, Burrell M, Rao S, Baker R. Incidence and risk factors for fatal pulmonary embolism after major trauma: A nested cohort study. Br J Anaesth. 2010;105:596–602.

    CAS  Article  Google Scholar 

  21. 21.

    Rogers FB, Cipolle MD, Velmahos G, Rozycki G, Luchette FA. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: The EAST practice management guidelines work group. J Trauma. 2002;53:142–64.

    Article  Google Scholar 

  22. 22.

    Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:e419S-e496S.

    CAS  Article  Google Scholar 

  23. 23.

    Byrne JP, Mason SA, Gomez D, Hoeft C, Subacius H, Xiong W, et al. Timing of Pharmacologic Venous Thromboembolism Prophylaxis in Severe Traumatic Brain Injury: A Propensity-Matched Cohort Study. J Am Coll Surg. 2016;223:621–31.

    Article  Google Scholar 

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Correspondence to Morgan Schellenberg.

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Conflict of interest

Authors Murphy, de Moya, Karam, Menard, Holder, Inaba, and Schellenberg declare that they have no conflict of interest.

Ethical approval

All procedures performed in this meta-analysis involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. No Institutional Review Board approval was necessary due to the meta-analysis nature of the study.

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Not applicable due to the meta-analysis nature of the study.

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Murphy, P.B., de Moya, M., Karam, B. et al. Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review. Eur J Trauma Emerg Surg (2021).

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  • Trauma
  • Deep vein thrombosis
  • Pulmonary embolism
  • Solid organ injury
  • Quality improvement