Venous thromboembolism in patients with traumatic pelvic and acetabular fractures: a retrospective cohort study.

Abstract

Studies on venous thromboembolism (VTE) in patients with traumatic pelvic and acetabular fractures have shown variable epidemiology, risk factors and outcomes. This retrospective study evaluated patients with traumatic pelvic and/or acetabular fractures who were admitted to a Level 1 trauma center in Riyadh, Saudi Arabia between January 2016 and December 2022. We compared patients who had VTE to those who did not. The study evaluated 437 patients with (median age: 37 years; 72.8% males). VTE occurred in 42 patients (9.6%), with deep-vein thrombosis and pulmonary embolism occurring at almost equal rates. Patients with VTE were older and more likely to receive tranexamic acid (16.7% vs. 9.9%, p = 0.06), red blood cell (26.2% vs. 13.2%, p = 0.02) and platelet (9.5% vs. 3.8%, p = 0.08) transfusions, and pelvic angioembolization (9.5% vs. 3.0%, p = 0.03). The most common associated injuries were chest injury (28.4%) and abdomen/pelvis injury (23.8%). Pharmacologic thromboprophylaxis was used in 94.1% of patients, predominantly enoxaparin. The significant predictors of VTE were age, admission to the intensive care unit (odds ratio 2.746, 95% confidence interval 1.041-7.240) and hospital length of stay. The timing of pharmacologic thromboprophylaxis was not significantly associated with VTE. Patients with VTE had similar hospital mortality compared with those without VTE (4.8% vs. 4.1%, respectively; p = 0.83) but stayed for a longer period in the hospital (median stay: 21.5 days vs. 12.0 days, respectively; p < 0.0001). VTE was diagnosed in almost 1 in 10 patients with traumatic pelvic and/or acetabular fractures. The need for admission to the intensive care unit, but not the timing of pharmacologic thromboprophylaxis, predicted VTE.