title: Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: is it safe?
abstract: BACKGROUND
  The aim of this study was to compare the safety of early (≤48 hours), intermediate (48 to 72 hours), and late (≥72 hours) venous thromboembolism prophylaxis in patients with blunt abdominal solid organ injury managed nonoperatively.
  
  
  METHODS
  We performed a 6-year (2006 to 2011) retrospective review of all trauma patients with blunt abdominal solid organ injuries. Patients were matched using propensity score matching in a 2:1:1 (early:intermediate:late) for age, gender, systolic blood pressure, Glasgow Coma Scale, Injury Severity Score, and type and grade of organs injured. Our primary outcome measures were: hemorrhage complications and need for intervention (operative intervention and/or angioembolization).
  
  
  RESULTS
  A total of 116 patients (58 early, 29 intermediate, and 29 late) were included. There were no differences in age (P = .5), Injury Severity Score (P = .6), type (P = .1), and grade of injury of the organ (P = .6) between the 3 groups. There were 67 liver (43.2%), 63 spleen (40.6%), 49 kidney (31.6%), and 24 multiple solid organ (15.4%) injuries. There was no difference in operative intervention (P = .8) and postprophylaxis blood transfusion (P = .3) between the 3 groups.
  
  
  CONCLUSIONS
  Early enoxaparin-based anticoagulation may be a safe option in trauma patients with blunt solid organ injury. This study showed no significant correlation between early anticoagulation and development of bleeding complications.
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA. Electronic address: bjoseph@surgery.arizona.edu.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Caitlyn
authors.initials: C
authors.lastname: Harrison
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Dafney
authors.initials: D
authors.lastname: Lubin
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.affiliation: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, The University of Arizona, 1501 N Campbell Avenue, Room 5511, Tucson, AZ 85724, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000628:therapy; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000628:therapy; D057216:Propensity Score; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000628:therapy
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin
keywords: Bleeding complications; Blunt solid organ injury; Failure of nonoperative management; Timing of venous thromboembolism prophylaxis; Venous thromboembolism prophylaxis