title: The safety of low molecular-weight heparin after blunt liver and spleen injuries.
abstract: BACKGROUND
  Anticoagulation is routinely administered to all trauma patients owing to the high incidence of venous thromboembolism (VTE). However, the timing of administration of anticoagulation is not clearly defined when patients have blunt spleen or liver injuries because of the perceived risk of hemorrhage with early administration.
  
  
  METHODS
  A retrospective chart review was performed of all blunt trauma patients who sustained blunt liver and/or spleen injuries during the 5-year period from 2007 to 2011. Data were collected for all patients managed with nonoperative therapy for these injuries while also receiving routine prophylactic anticoagulation with low molecular-weight heparin. Patients were categorized based on the initiation of enoxaparin therapy after injury: early (<48 hours), intermediate (48 to 72 hours), and late (>72 hours). Primary and secondary outcomes were designated as need for operative or radiologic intervention secondary to spleen or liver hemorrhage, number of transfusions, and incidence of VTE.
  
  
  RESULTS
  Three hundred and twenty-eight patients were included. There were no enoxaparin-related hemorrhagic complications or hemorrhage necessitating operative intervention. Patients in the early, intermediate, and late groups received an average of .9, .93, and 1.55 units of blood, respectively. There was 1 pulmonary embolism in the early group, and there were 6 VTE complications in the late group (3 deep venous thromboses and 3 pulmonary embolisms).
  
  
  CONCLUSIONS
  There are currently no standards for the initiation of prophylactic anticoagulation in trauma patients with blunt liver and spleen injuries. Early administration may be safe and reduce the incidence of thrombotic complications in patients with blunt spleen and liver injuries. Prospective studies in this area are warranted.
authors.affiliation: Division of Trauma, Burn, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Rostas
authors.affiliation: Department of Surgery, University of Mississippi, College of Medicine, Jackson, MS, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Manley
authors.affiliation: Division of Trauma, Burn, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Gonzalez
authors.affiliation: Division of Trauma, Burn, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA.
authors.forename: Sidney B
authors.initials: SB
authors.lastname: Brevard
authors.affiliation: Department of Surgery, University of Mississippi, College of Medicine, Jackson, MS, USA.
authors.forename: Naveed
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: Division of Trauma, Burn, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA.
authors.forename: Mohammad Amin
authors.initials: MA
authors.lastname: Frotan
authors.affiliation: Division of Trauma, Burn, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Mitchell
authors.affiliation: Division of Trauma, Burn, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of South Alabama College of Medicine, Mobile, AL, USA. Electronic address: jdsimmons@health.southalabama.edu.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Simmons
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008099:Liver / Q000293:injuries*; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000628:therapy*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Blunt trauma; Liver injury; Prophylaxis; Splenic injury; Venous thromboembolism