The role of systemic intraoperative anticoagulation (SIAC) during surgical repair of major arterial injuries is controversial. Any potential improvement in arterial patency must be weighed against the risk of hemorrhage in these critically injured patients. We hypothesized that SIAC would increase arterial patency without increasing bleeding complications.
We conducted a multi-institution, retrospective cohort study of trauma patients with major vascular injury from 2005-2013 in 3 level I centers. Arterial injuries of the neck, torso and proximal extremities requiring operative management were included. Our primary endpoint was maintenance of arterial patency during index hospitalization. Complications related to bleeding were assessed. The association between SIAC and arterial patency was evaluated using Chi-Square, t-test and multiple logistic regression modeling.
Of 323 study patients, most were male (88%) and injured by gunshot wounds (69%). Patients repaired with SIAC (n=154) were compared to those repaired without SIAC (n=169). No difference in age, gender, mechanism, admission heart rate, or concomitant injury was detected between the groups (all p>0.05). SIAC use was associated with greater arterial patency rates (93% vs. 85%, p=0.02) without increasing return to OR for bleeding (4% vs. 6%, p=0.29). After controlling for gender, admission hemodynamics, ISS, injury location and postoperative anticoagulation, multivariable regression determined SIAC patients were 2.6 times more likely (OR 2.6, 95%CI 1.1-6.2, p=0.03) to maintain patency. Patients who maintained arterial patency were then less likely to return to the OR (9% vs. 78%, p<0.001) with shorter ICU (median 3 vs. 9 days, p<0.01) and hospital LOS (median 13 vs. 21 days, p<0.01).
Patients who underwent operative repair of arterial injuries utilizing SIAC experienced better arterial patency without additional bleeding complications as compared to those repaired without SIAC. Our data suggests that SIAC may improve arterial patency rates after repair and the attributable bleeding risk of SIAC may be overstated.
Therapeutic/Care Management, Level III.
This research output has an Altmetric Attention Score of 16. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 January 2025.
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