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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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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Funding

No funding was received for this study.

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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). https://doi.org/10.1007/s00068-021-01783-0

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Keywords

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