title: Early pharmacological venous thromboembolism prophylaxis is safe after operative fixation of traumatic spine fractures.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To examine the impact of early (<48 hr) versus late (≥48 hr) initiation of pharmacological venous thromboembolism (VTE) prophylaxis on outcomes and complications among trauma patients undergoing operative fixation of spine fractures.
  
  
  BACKGROUND
  VTE complications are associated with poor outcomes after trauma. Although pharmacological prophylaxis decreases the risk of VTE after trauma, concerns regarding bleeding-related complications among certain patient subgroups persist. At present, there are limited data regarding the safety of early VTE prophylaxis in trauma patients undergoing operative fixation of spine fractures.
  
  
  METHODS
  We performed a 5-year retrospective analysis of our level 1 trauma center registry to identify consecutive patients undergoing operative fixation of spine fractures. Demographics, injury patterns and severity, details of operative procedures, timing of administration of VTE prophylaxis, and outcomes were analyzed. Patients receiving early VTE prophylaxis were compared with patients receiving late VTE prophylaxis. Multivariate analysis was performed to identify independent predictors of VTE.
  
  
  RESULTS
  Of 1432 patients with spine fractures, 206 patients (14.4%) underwent operative fixation. Forty-eight (23.3%) received early VTE prophylaxis and 158 (76.7%) received late VTE prophylaxis. No patient developed an epidural hematoma or postoperative bleeding necessitating intervention in either group. Thirteen patients (6.2%) developed VTE, of which 12 occurred in the late VTE prophylaxis group. Age 45 years or more (odds ratio = 5.12, 95% confidence interval = 1.01-25.94, P = 0.048) and traumatic brain injury (odds ratio = 6.94, 95% confidence interval = 1.19-40.35, P = 0.031) were independently associated with an increased risk for VTE.
  
  
  CONCLUSIONS
  Pharmacological VTE prophylaxis initiated within 48 hours of operative fixation of traumatic spine fractures seems to be safe and is not associated with an increased risk of bleeding or neurological complications. Large, multicenter prospective studies are required to further define the efficacy and safety of an early pharmacological VTE prophylaxis strategy in this at-risk patient population.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Surgery, Division of Trauma, Surgical Critical Care, and Burns, University of California San Diego Health Sciences, San Diego, CA.
authors.forename: Dennis Yong
authors.initials: DY
authors.lastname: Kim
authors.forename: Leslie
authors.initials: L
authors.lastname: Kobayashi
authors.forename: David
authors.initials: D
authors.lastname: Chang
authors.forename: Dale
authors.initials: D
authors.lastname: Fortlage
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
mesh_terms: D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D015912:Thrombolytic Therapy / Q000379:methods*; D014193:Trauma Centers; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*; D055815:Young Adult