Early pharmacologic thromboprophylaxis after splenectomy is associated with better outcomes: A matched cohort study

Delbrynth P Mitchao; Meghan R Lewis; Elizabeth R Benjamin; Dominik A Jakob; Demetrios Demetriades

doi:10.1016/j.amjsurg.2022.01.030

Early pharmacologic thromboprophylaxis after splenectomy is associated with better outcomes: A matched cohort study

Am J Surg. 2022 Jul;224(1 Pt B):535-538. doi: 10.1016/j.amjsurg.2022.01.030. Epub 2022 Feb 1.

Authors

Delbrynth P Mitchao¹, Meghan R Lewis², Elizabeth R Benjamin³, Dominik A Jakob⁴, Demetrios Demetriades⁵

Affiliations

¹ Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: delbrynth.mitchao@icloud.com.
² Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: meghan.lewis@med.usc.edu.
³ Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: Elizabeth.robinson.benjamin@emory.edu.
⁴ Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: d.jakob@swissonline.ch.
⁵ Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: demetrios.demetriades@med.usc.edu.

PMID: 35151431
DOI: 10.1016/j.amjsurg.2022.01.030

Abstract

Background: This study aimed to explore the timing of pharmacologic prophylaxis initiation after trauma splenectomy and the development of venous thromboembolism (VTE).

Methods: Retrospective review of American College of Surgeons Trauma Quality Improvement Program (TQIP) database 2013-2017. Adults (>16 years) with isolated splenic injuries who underwent splenectomy and received pharmacologic VTE prophylaxis were stratified based on timing of initiation of prophylaxis: ≤48 h (EARLY) or > 48 h (LATE) from admission. Patients were matched for demographic and clinical characteristics and outcomes compared.

Results: 3631 patients were included. On logistic regression, LATE prophylaxis was associated with DVT (OR 2.317, p < 0.001) and VTE (OR 2.064, p < 0.001). Low molecular weight heparin (LMWH) was protective for DVT (OR 0.621, p = 0.014) and VTE (OR 0.667, p = 0.015). 1196 patients with EARLY prophylaxis were matched with 1196 patients with LATE prophylaxis. VTE and overall complications were significantly higher in the LATE group (7.4% vs. 4.3%, p = 0.001 and 25.8% vs 16.6%, p < 0.001).

Conclusions: Late initiation of VTE prophylaxis is associated with DVT and VTE in post-splenectomy patients, while LMWH is protective.

MeSH terms

Adult
Anticoagulants / therapeutic use
Cohort Studies
Heparin, Low-Molecular-Weight* / therapeutic use
Humans
Retrospective Studies
Splenectomy / adverse effects
Venous Thromboembolism* / etiology
Venous Thromboembolism* / prevention & control

Substances

Anticoagulants
Heparin, Low-Molecular-Weight