BREAKING DOWN THE EVIDENCE: A MULTICENTER ANALYSIS OF VENOUS THROMBOEMBOLISM AMONG TRAUMA PATIENTS WITH LOWER EXTREMITY FRACTURES.

Abstract

To determine whether chemoprophylaxis initiation within 24 hours reduces venous thromboembolism risk among trauma patients with lower extremity long bone fractures. Design: This was a retrospective cohort study. 17 Level I trauma centers as a part of the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) study group. Patients aged 18-40 years with a diagnosis of lower extremity long bone fracture between January 1, 2018 to December 31, 2020 were included. 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. 120 (5.3%) among 2,264 patients with lower extremity fractures developed VTE. 57.5% received E-PROPH and 42.5% received L-PROPH. 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 L-PROPH group than in 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 complications model (aOR 1.84, 95% CI 0.75, 4.57). 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 III: retrospective cohort study.