Lisa M Knowlton, Jacob G Guorgui, Simeng Wang, Katherine Arnow, M Margaret Knudson
{"title":"Breaking Down the Evidence: A Multicenter Analysis of Venous Thromboembolism Among Trauma Patients with Lower Extremity Fractures.","authors":"Lisa M Knowlton, Jacob G Guorgui, Simeng Wang, Katherine Arnow, M Margaret Knudson","doi":"10.1097/BOT.0000000000003174","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether chemoprophylaxis initiation within 24 hours reduces venous thromboembolism (VTE) risk among trauma patients with lower extremity long bone fractures.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>This was a retrospective cohort study.</p><p><strong>Setting: </strong>Seventeen Level I trauma centers as a part of the Consortium of Leaders in the Study of Traumatic Thromboembolism study group.</p><p><strong>Patient selection criteria: </strong>Patients aged 18-40 years with a diagnosis of lower extremity long bone fracture between January 1, 2018, and December 31, 2020, were included.</p><p><strong>Outcome measures and comparisons: </strong>Primary outcome was VTE during admission. Patients were compared based on VTE chemoprophylaxis initiation within 24 hours (early prophylaxis, E-PROPH) versus not (late or no prophylaxis, L-PROPH) using inverse probability weighted Cox survival analysis.</p><p><strong>Results: </strong>In total, 120 (5.3%) among 2264 patients with lower extremity fractures developed VTE. 57.5% received E-PROPH and 42.5% received L-PROPH. The E-PROPH group had fewer patients with an injury severity score ≥16 (30.3% vs. 52.4%, P < 0.001) and a lower proportion of associated head injury (8.1% vs. 26.7%, P < 0.001). VTE incidence was significantly higher in the L-PROPH group than in the E-PROPH group (8.6% vs. 2.8%, P < 0.001). In the adjusted model, E-PROPH was independently associated with nearly a half reduction in VTE incidence (hazard ratio: 0.54, 95% confidence interval, 0.34-0.85). There was no significant difference in the adjusted bleeding complication model (aOR 1.84; 95% confidence interval, 0.75-4.57).</p><p><strong>Conclusion: </strong>VTE chemoprophylaxis within the first 24 hours of admission was associated with a marked reduction in VTE incidence among patients with traumatic lower extremity long bone fractures without increase in bleeding risks.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"e164-e170"},"PeriodicalIF":2.0000,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000003174","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To determine whether chemoprophylaxis initiation within 24 hours reduces venous thromboembolism (VTE) risk among trauma patients with lower extremity long bone fractures.
Methods:
Design: This was a retrospective cohort study.
Setting: Seventeen Level I trauma centers as a part of the Consortium of Leaders in the Study of Traumatic Thromboembolism study group.
Patient selection criteria: Patients aged 18-40 years with a diagnosis of lower extremity long bone fracture between January 1, 2018, and December 31, 2020, were included.
Outcome measures and comparisons: Primary outcome was VTE during admission. Patients were compared based on VTE chemoprophylaxis initiation within 24 hours (early prophylaxis, E-PROPH) versus not (late or no prophylaxis, L-PROPH) using inverse probability weighted Cox survival analysis.
Results: In total, 120 (5.3%) among 2264 patients with lower extremity fractures developed VTE. 57.5% received E-PROPH and 42.5% received L-PROPH. The E-PROPH group had fewer patients with an injury severity score ≥16 (30.3% vs. 52.4%, P < 0.001) and a lower proportion of associated head injury (8.1% vs. 26.7%, P < 0.001). VTE incidence was significantly higher in the L-PROPH group than in the E-PROPH group (8.6% vs. 2.8%, P < 0.001). In the adjusted model, E-PROPH was independently associated with nearly a half reduction in VTE incidence (hazard ratio: 0.54, 95% confidence interval, 0.34-0.85). There was no significant difference in the adjusted bleeding complication model (aOR 1.84; 95% confidence interval, 0.75-4.57).
Conclusion: VTE chemoprophylaxis within the first 24 hours of admission was associated with a marked reduction in VTE incidence among patients with traumatic lower extremity long bone fractures without increase in bleeding risks.
Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的：确定24小时内开始化学预防是否能降低下肢长骨骨折创伤患者静脉血栓栓塞的风险。设计：这是一项回顾性队列研究。背景：17个一级创伤中心作为创伤性血栓栓塞研究（CLOTT）研究组领导联盟的一部分。患者选择标准：纳入2018年1月1日至2020年12月31日诊断为下肢长骨骨折的患者，年龄18-40岁。结果测量和比较：主要结果是入院时静脉血栓栓塞。采用逆概率加权Cox生存分析，比较患者在24小时内开始静脉血栓栓塞化学预防（早期预防，E-PROPH）与未开始（晚期或无预防，L-PROPH）。结果：2264例下肢骨折患者中有120例（5.3%）发生静脉血栓栓塞。57.5%接受E-PROPH治疗，42.5%接受L-PROPH治疗。E-PROPH组损伤严重程度评分为16的患者较少（30.3% vs. 52.4%）。结论：入院前24小时内静脉血栓栓塞化学预防与创伤性下肢长骨骨折患者静脉血栓栓塞发生率显著降低相关，且不增加出血风险。证据等级：III级：回顾性队列研究。
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
