Direct Oral Anticoagulants Are a Potential Alternative to Low-Molecular-Weight Heparin for Thromboprophylaxis in Trauma Patients Sustaining Lower Extremity Fractures
| Autor: | Kerry Breen, Inger B. Schipper, Pieta Krijnen, Menno V. Huisman, Charlie J. Nederpelt, Haytham M.A. Kaafarani, Martin G. Rosenthal, Majed El Hechi |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class Population Psychological intervention Low molecular weight heparin Trauma Fractures Bone 03 medical and health sciences 0302 clinical medicine Bones of Lower Extremity Internal medicine Humans Medicine Thromboprophylaxis education Aged Retrospective Studies Aged 80 and over Lower extremity education.field_of_study Femur fracture business.industry Anticoagulants Trauma quality improvement program Venous Thromboembolism Heparin Heparin Low-Molecular-Weight Middle Aged 030220 oncology & carcinogenesis Propensity score matching Orthopedic surgery Female 030211 gastroenterology & hepatology Surgery business Direct oral anticoagulant medicine.drug |
| Zdroj: | Journal of Surgical Research, 258, 324-331. ACADEMIC PRESS INC ELSEVIER SCIENCE |
| ISSN: | 0022-4804 |
| Popis: | Background: Trauma patients are at a significant risk of venous thromboembolism (VTE), with lower extremity fractures (LEF) being independent risk factors. Use of direct oral anticoagusants (DOACs) for VTE prophylaxis is effective in elective orthopedic surgery, but currently not approved for trauma patients. The primary objective of this study was to compare the effectiveness and safety of thromboprophylaxis of DOACs with lowmolecular-weight heparin (LMWH) in trauma patients sustaining LEF.Materials and methods: We included adult trauma patients admitted to trauma quality improvement program participating trauma centers (between 2013 and 2016), who sustained LEF and were started on DOACs or LMWH for thromboprophylaxis after admission. Propensity score matching was performed to compare symptomatic VTE and bleeding control interventions between the groups.Results: Of 1,009,922 patients in trauma quality improvement program, 167,640 met inclusion criteria (165,009 received LMWH and 2631 received DOACs). After propensity score matching, 2280 predominantly elderly (median age: 67 y) isolated femur fracture patients (median ISS: 10) were included in each group (4560 patients in total). Symptomatic VTE occurred in 1.4% of patients in both matched groups (P = 0.992). Bleeding control interventions occurred less often in the DOAC group, albeit statistically insignificant (5.8% versus 6.0%, P = 0.772).Conclusions: This study found similar rates of VTE and bleeding control measures for thromboprophylaxis with DOACs or LMWH in matched trauma patients with LEF. Further prospective research is warranted to consolidate the safety of DOAC thromboprophylaxis in trauma patients with LEF. Favorable oral administration and likely increased adherence could benefit this high-risk population. (C) 2020 The Authors. Published by Elsevier Inc. |
| Databáze: | OpenAIRE |
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