Direct Oral Anticoagulants vs Low-Molecular–Weight Heparin for Thromboprophylaxis in Nonoperative Pelvic Fractures

Mohammad Hamidi, Muhammad Zeeshan, Joseph V. Sakran, Narong Kulvatunyou, Terence S Okeeffe, Ashley Northcutt, El Rasheid Zakaria, Andrew - Tang, Bellal A Joseph

Research output: Contribution to journalArticle

Abstract

Background: Patients with pelvic fractures are prone to venous thromboembolic (VTE) complications. Recent literature shows superiority of direct oral anticoagulants (DOACs) over low-molecular–weight heparin (LMWH) for thromboprophylaxis in patients undergoing orthopaedic operations. The aim of our study was to compare in-hospital outcomes for DOACs vs LMWH in patients with nonoperative pelvic fractures. Study Design: We performed a 2-year (2015 to 2016) analysis of the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) database. We included all adult patients with isolated blunt pelvic fractures who were managed nonoperatively and received thromboprophylaxis with either LMWH or DOACs (Factor-Xa inhibitor or direct thrombin inhibitor). Patients were divided into 2 groups based on receipt of DOACs vs LMWH and were propensity-score-matched in a 1:2 ratio to control for possible confounding factors. Primary outcomes were deep venous thrombosis (DVT) and/or pulmonary embolism (PE). Secondary outcomes were pRBC transfusions, intervention for hemorrhage control, and in-hospital mortality after initiation of thromboprophylaxis. Results: We identified 20,692 patients with pelvic fractures. There were 7,312 patients with isolated pelvic fractures included, 852 of whom were matched (DOACs: 284; LMWH: 568). Mean age was 43.2 ± 15 years, median Injury Severity Score was 14 (range 10 to 18). Matched groups were similar in demographics, vital signs, injury parameters, and timing of initiation of thromboprophylaxis. Overall, 5.2% of patients had DVT, 1.4% PE, and 1.3% died. Patients who received DOACs were less likely to develop DVT (1.8% vs 6.9%, p < 0.01) compared with LMWH. There was no difference in PE (p = 0.85) or in-hospital mortality (p = 0.79) between the 2 groups. Similarly, there was no difference in post-prophylaxis blood transfusion, and post-prophylaxis intervention for hemorrhage control. Conclusions: In patients with nonoperative pelvic fractures, DOACs were associated with a reduced rate of DVT vs LMWH without increasing the risk of bleeding complications. No association was found between the type of thromboprophylactic agent and rates of PE or in-hospital mortality.

Original languageEnglish (US)
Pages (from-to)89-97
Number of pages9
JournalJournal of the American College of Surgeons
Volume228
Issue number1
DOIs
StatePublished - Jan 1 2019

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Anticoagulants
Heparin
Pulmonary Embolism
Venous Thrombosis
Hospital Mortality
Hemorrhage
Propensity Score
Injury Severity Score
Antithrombins
Vital Signs
Wounds and Injuries
Quality Improvement
Blood Transfusion
Orthopedics
Research Design
Demography
Databases

ASJC Scopus subject areas

  • Surgery

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Direct Oral Anticoagulants vs Low-Molecular–Weight Heparin for Thromboprophylaxis in Nonoperative Pelvic Fractures. / Hamidi, Mohammad; Zeeshan, Muhammad; Sakran, Joseph V.; Kulvatunyou, Narong; Okeeffe, Terence S; Northcutt, Ashley; Zakaria, El Rasheid; Tang, Andrew -; Joseph, Bellal A.

In: Journal of the American College of Surgeons, Vol. 228, No. 1, 01.01.2019, p. 89-97.

Research output: Contribution to journalArticle

Hamidi, Mohammad ; Zeeshan, Muhammad ; Sakran, Joseph V. ; Kulvatunyou, Narong ; Okeeffe, Terence S ; Northcutt, Ashley ; Zakaria, El Rasheid ; Tang, Andrew - ; Joseph, Bellal A. / Direct Oral Anticoagulants vs Low-Molecular–Weight Heparin for Thromboprophylaxis in Nonoperative Pelvic Fractures. In: Journal of the American College of Surgeons. 2019 ; Vol. 228, No. 1. pp. 89-97.
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AU - Hamidi, Mohammad

AU - Zeeshan, Muhammad

AU - Sakran, Joseph V.

AU - Kulvatunyou, Narong

AU - Okeeffe, Terence S

AU - Northcutt, Ashley

AU - Zakaria, El Rasheid

AU - Tang, Andrew -

AU - Joseph, Bellal A

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N2 - Background: Patients with pelvic fractures are prone to venous thromboembolic (VTE) complications. Recent literature shows superiority of direct oral anticoagulants (DOACs) over low-molecular–weight heparin (LMWH) for thromboprophylaxis in patients undergoing orthopaedic operations. The aim of our study was to compare in-hospital outcomes for DOACs vs LMWH in patients with nonoperative pelvic fractures. Study Design: We performed a 2-year (2015 to 2016) analysis of the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) database. We included all adult patients with isolated blunt pelvic fractures who were managed nonoperatively and received thromboprophylaxis with either LMWH or DOACs (Factor-Xa inhibitor or direct thrombin inhibitor). Patients were divided into 2 groups based on receipt of DOACs vs LMWH and were propensity-score-matched in a 1:2 ratio to control for possible confounding factors. Primary outcomes were deep venous thrombosis (DVT) and/or pulmonary embolism (PE). Secondary outcomes were pRBC transfusions, intervention for hemorrhage control, and in-hospital mortality after initiation of thromboprophylaxis. Results: We identified 20,692 patients with pelvic fractures. There were 7,312 patients with isolated pelvic fractures included, 852 of whom were matched (DOACs: 284; LMWH: 568). Mean age was 43.2 ± 15 years, median Injury Severity Score was 14 (range 10 to 18). Matched groups were similar in demographics, vital signs, injury parameters, and timing of initiation of thromboprophylaxis. Overall, 5.2% of patients had DVT, 1.4% PE, and 1.3% died. Patients who received DOACs were less likely to develop DVT (1.8% vs 6.9%, p < 0.01) compared with LMWH. There was no difference in PE (p = 0.85) or in-hospital mortality (p = 0.79) between the 2 groups. Similarly, there was no difference in post-prophylaxis blood transfusion, and post-prophylaxis intervention for hemorrhage control. Conclusions: In patients with nonoperative pelvic fractures, DOACs were associated with a reduced rate of DVT vs LMWH without increasing the risk of bleeding complications. No association was found between the type of thromboprophylactic agent and rates of PE or in-hospital mortality.

AB - Background: Patients with pelvic fractures are prone to venous thromboembolic (VTE) complications. Recent literature shows superiority of direct oral anticoagulants (DOACs) over low-molecular–weight heparin (LMWH) for thromboprophylaxis in patients undergoing orthopaedic operations. The aim of our study was to compare in-hospital outcomes for DOACs vs LMWH in patients with nonoperative pelvic fractures. Study Design: We performed a 2-year (2015 to 2016) analysis of the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) database. We included all adult patients with isolated blunt pelvic fractures who were managed nonoperatively and received thromboprophylaxis with either LMWH or DOACs (Factor-Xa inhibitor or direct thrombin inhibitor). Patients were divided into 2 groups based on receipt of DOACs vs LMWH and were propensity-score-matched in a 1:2 ratio to control for possible confounding factors. Primary outcomes were deep venous thrombosis (DVT) and/or pulmonary embolism (PE). Secondary outcomes were pRBC transfusions, intervention for hemorrhage control, and in-hospital mortality after initiation of thromboprophylaxis. Results: We identified 20,692 patients with pelvic fractures. There were 7,312 patients with isolated pelvic fractures included, 852 of whom were matched (DOACs: 284; LMWH: 568). Mean age was 43.2 ± 15 years, median Injury Severity Score was 14 (range 10 to 18). Matched groups were similar in demographics, vital signs, injury parameters, and timing of initiation of thromboprophylaxis. Overall, 5.2% of patients had DVT, 1.4% PE, and 1.3% died. Patients who received DOACs were less likely to develop DVT (1.8% vs 6.9%, p < 0.01) compared with LMWH. There was no difference in PE (p = 0.85) or in-hospital mortality (p = 0.79) between the 2 groups. Similarly, there was no difference in post-prophylaxis blood transfusion, and post-prophylaxis intervention for hemorrhage control. Conclusions: In patients with nonoperative pelvic fractures, DOACs were associated with a reduced rate of DVT vs LMWH without increasing the risk of bleeding complications. No association was found between the type of thromboprophylactic agent and rates of PE or in-hospital mortality.

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