肝血管栓塞术后启动血栓预防的最佳时机

IF 7.5 1区 医学 Q1 SURGERY
Annals of surgery Pub Date : 2024-10-01 Epub Date: 2024-06-11 DOI:10.1097/SLA.0000000000006381
Brianna L Collie, Nicole B Lyons, Logan Goddard, Michael D Cobler-Lichter, Jessica M Delamater, Larisa Shagabayeva, Edward B Lineen, Carl I Schulman, Kenneth G Proctor, Jonathan P Meizoso, Nicholas Namias, Enrique Ginzburg
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引用次数: 0

摘要

目的:评估创伤患者肝血管栓塞术后开始血栓预防(TPX)的最佳时机:评估创伤患者肝血管栓塞术后开始血栓预防(TPX)的最佳时机:肝外伤后的 TPX 因出血风险而变得复杂,但肝血管栓塞术后的相对风险尚不清楚:从 2017-19 年 ACS TQIP 数据集中回顾性地识别了 24 小时内接受肝血管栓塞术的患者。病例与结果:在 1550 例患者中,1370 例进行了首次血管栓塞术。24小时内开始TPX治疗的患者出血并发症更高(20.0% vs 8.9%,PC结论:这是第一项针对全国创伤患者样本进行肝血管栓塞术后 TPX 时间选择的研究。对这些患者而言,在 48-72 小时内开始 TPX 在减少出血的同时降低 VTE 风险方面实现了最安全的平衡:III级--回顾性队列研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optimal Timing for Initiation of Thromboprophylaxis After Hepatic Angioembolization.

Objective: To evaluate the optimal timing of thromboprophylaxis (TPX) initiation after hepatic angioembolization in trauma patients.

Background: TPX after hepatic trauma is complicated by the risk of bleeding, but the relative risk after hepatic angioembolization is unknown.

Methods: Patients who underwent hepatic angioembolization within 24 hours were retrospectively identified from the 2017 to 2019 American College of Surgeons Trauma Quality Improvement Project data sets. Cases with <24-hour length of stay and other serious injuries were excluded. Venous thromboembolism (VTE) included deep venous thrombosis and PE. Bleeding complications included hepatic surgery, additional angioembolization, or blood transfusion after TPX initiation. Differences were tested with univariate and multivariate analyses.

Results: Of 1550 patients, 1370 had initial angioembolization. Bleeding complications were higher in those with TPX initiation within 24 hours (20.0% vs 8.9%, P <0.001) and 48 hours (13.2% vs 8.4%, P =0.013). However, VTE was higher in those with TPX initiation after 48 hours (6.3% vs 3.3%, P =0.025). In the 180 patients with hepatic surgery before angioembolization, bleeding complications were higher in those with TPX initiation within 24 hours (72% vs 20%, P <0.001), 48 hours (50% vs 17%, P <0.001), and 72 hours (37% vs 14%, P =0.001). Moreover, deep venous thrombosis was higher in those with TPX initiation after 96 hours (14.3% vs 3.1%, P =0.023).

Conclusions: This is the first study to address the timing of TPX after hepatic angioembolization in a national sample of trauma patients. For these patients, initiation of TPX at 48 to 72 hours achieves the safest balance in minimizing bleeding while reducing the risk of VTE.

Level of evidence: Level III-retrospective cohort study.

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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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