Lisa Marie Knowlton (Stanford, CA / US), Angela Sauaia (Aurora, CO / US), Ernest E. Moore (Aurora, CO / US), M. Margaret Knudson (San Francisco, CA / US)
Background: Pelvic fractures are associated with high venous thromboembolism (VTE) risk. Among pelvic angioembolization (PA), preperitoneal pelvic packing (PPP) and open reduction internal fixation (ORIF), PPP is postulated as a VTE risk factor. We characterized VTE risk among pelvic fracture patients receiving PPP, PA or ORIF.
Patients & Methods: We used prospectively collected data from a 17-site Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) study group, one of the largest U.S. level I trauma center collaboratives studying posttraumatic VTE. We studied ICU level of care trauma patients 18-40 years with pelvic fracture and at least 1 VTE risk factor, comparing: PPP, angioembolization, and ORIF to our reference of no pelvic intervention. Our primary outcome was in-hospital VTE formation. A competing risk survival analysis censored for death and accounted for facility clustering.
Results: 1,387 trauma patients with pelvic fractures were analyzed, with VTE incidence of 5.6%. 17.3% ORIF patients developed a VTE, compared to 2.1% with PPP and 1.0% who underwent PA. Compared to no VTE, unadjusted analyses of those who developed had lower admission systolic blood pressure (median 115 vs. 125, p<0.0001) and higher injury severity score (ISS) (median 29 vs. 17, p<0.0001). In competing risk survival analysis, none of the three treatments were significantly associated with VTE. Initiation of VTE prophylaxis in the first 24 hours of admission was independently associated with VTE reduction (hazard ratio HR: 0.55, confidence interval CI: 0.33-0.91).
Conclusion: Pelvic packing, ORIF or embolization are not independent risk factors for VTE. Early VTE pharmacoprophylaxis is critical to decreasing VTE formation in this high-risk population.
References: Knudson MM, et al. Challenging Traditional Paradigms in Posttraumatic Pulmonary Thromboembolism. JAMA Surg. 2022;157(2).
Figure 1. Adjusted Analysis of Factors Associated with Venous Thromboembolism
There are no disclosures or conflicts of interest for any of the authors.
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