Venous thromboembolism (VTE) after major vascular injury (MVI) is particularly challenging as the competing risk of thrombosis and embolization after direct vessel injury must be balanced with risk of bleeding after surgical repair. We hypothesized that venous injuries, repair type and intraoperative anticoagulation would influence VTE formation after MVI.
A multi-institution, retrospective cohort study of consecutive MVI patients was conducted at 3 urban, level-I centers (2005-2013). Patients with MVI of the neck, torso, or proximal extremities (to elbows/knees) were included. Our primary study endpoint was the development of VTE (DVT or PE).
The 435 MVI patients were primarily young (27 years) males (89%) with penetrating (84%) injuries. When patients with (n=108) and without (n=327) VTE were compared, we observed no difference in age, mechanism, extremity injury, tourniquet use, orthopedic and spine injuries, damage control, local heparinized saline or vascular surgery consultation (all p>0.05). VTE patients had greater ISS (17 vs. 12), shock indices (1 vs. 0.9), and more torso (58% vs. 35%) and venous (73% vs. 48%) injuries, but less often received systemic intraoperative anticoagulation (39% vs. 53%) or postoperative enoxaparin (47% vs. 61%) prophylaxis (all p<0.05). After controlling for ISS, hemodynamics, injured vessel, intraoperative anticoagulation and postoperative prophylaxis, multivariable analysis revealed venous injury was independently predictive of VTE (OR 2.7, p=0.002). Multivariable analysis of the venous injuries subset (n=237) then determined that only delay in starting VTE chemoprophylaxis (OR 1.3/day, p=0.013) independently predicted VTE after controlling for ISS, hemodynamics, injured vessel, surgical subspecialty, intraoperative anticoagulation and postoperative prophylaxis. Overall, 3.4% of venous injury patients developed PE, but PE rates were not related to their operative management (p=0.72).
Patients with major venous injuries are at high-risk for VTE, regardless of intraoperative management. Our results support the immediate initiation of postoperative chemoprophylaxis in patients with major venous injuries.
Therapeutic/Care Management, Level III.
This research output has an Altmetric Attention Score of 15. 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 22 August 2019.
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