Oral thromboprophylaxis in pelvic trauma: a standardized protocol.

Abstract

BACKGROUND:

Thromboprophylaxis for deep vein thrombosis (DVT) after lower-extremity trauma could include rivaroxaban, an oral medication that does not need laboratory monitoring.

OBJECTIVE:

To assess rivaroxaban's efficacy in preventing DVTs after pelvic trauma compared to its historical incidence.

MATERIALS AND METHODS:

All patients admitted with pelvic fractures in a 12-month period followed a standardized thromboprophylaxis protocol: 1) rivaroxaban 10 mg/day within 24 h of injury or upon hemodynamic stability; 2) pre-operative, post-operative, and 30-day extremity ultrasound; 3) ventilation-perfusion scintigraphy for clinical signs of pulmonary embolus; and 4) a 45-, 90-, and 120-day re-evaluation. Rivaroxaban administration ceased the day of surgery and restarted 12 h post-operatively or upon hemodynamic stability, continuing for 30 days. Excluded patients had severe neurological or hepatosplenic injuries, heparin hypersensitivity, or hemodynamic instability.

RESULTS:

Of 113 patients assessed, 84 patients (66 males), average age 46.6 years (range 19-69 years), were included. They had isolated pelvic trauma (n = 37), associated lower limb injuries (n = 47), average Injury Severity Score 21.4 (range 16-50), and average Glasgow Coma Scale score 13.6 (range 9-15). Patients receiving thromboprophylaxis soon after their fracture (n = 64) had a lower incidence of DVT than those receiving delayed thromboprophylaxis (n = 20) (p = 0.02). One patient (1.2%) died from a pulmonary embolus; 13 had asymptomatic below-the-knee DVTs. Rivaroxaban did not increase intra- or post-operative bleeding in surgical wounds.

CONCLUSIONS:

DVT incidence after pelvic fractures is reduced by administering antithrombotics within 24 h of injury or, if the patient is hemodynamically unstable, 24 h after stabilization. Rivaroxaban is a safe and effective method of providing this thromboprophylaxis.

• Authors: Daniel Godoy Monzon, Kenneth V Iserson, Alberto Cid, Jorge A Vazquez
• Journal: The Journal of emergency medicine (J Emerg Med) Vol. 43 Issue 4 Pg. 612-7 (Oct 2012) ISSN: 0736-4679 [Print] United States
• PMID: 22244290 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Morpholines
• Thiophenes
• Rivaroxaban

Topics

• Adult
• Aged
• Anticoagulants (administration & dosage, therapeutic use)
• Drug Administration Schedule
• Female
• Fractures, Bone (complications, surgery)
• Glasgow Coma Scale
• Humans
• Injury Severity Score
• Lower Extremity (blood supply, diagnostic imaging, injuries)
• Male
• Middle Aged
• Morpholines (administration & dosage, therapeutic use)
• Pelvic Bones (injuries)
• Pulmonary Embolism (diagnostic imaging)
• Radionuclide Imaging
• Rivaroxaban
• Thiophenes (administration & dosage, therapeutic use)
• Time Factors
• Ultrasonography
• Venous Thrombosis (diagnosis, etiology, prevention & control)
• Young Adult