TY - JOUR
T1 - Hypercoagulability following blunt solid abdominal organ injury
T2 - When to initiate anticoagulation
AU - Chapman, Brandon C.
AU - Moore, Ernest E.
AU - Barnett, Carlton
AU - Stovall, Robert T.
AU - Biffl, Walter L.
AU - Burlew, Clay C.
AU - Bensard, Denis D.
AU - Jurkovich, Gregory
AU - Pieracci, Fredric M.
PY - 2013/12/1
Y1 - 2013/12/1
N2 - Background The optimal time to initiate venous thromboembolism pharmacoprophylaxis after blunt abdominal solid organ injury is unknown. Methods Postinjury coagulation status was characterized using thromboelastography (TEG) in trauma patients with blunt abdominal solid organ injuries; TEG was divided into 12-hour intervals up to 72 hours. Results Forty-two of 304 patients (13.8%) identified underwent multiple postinjury thromboelastographic studies. Age (P =.45), gender (P =.45), and solid organ injury grade (P =.71) were similar between TEG and non-TEG patients. TEG patients had higher Injury Severity Scores compared with non-TEG patients (33.2 vs 18.3, respectively, P <.01). Among the TEG patients, the shear elastic modulus strength and maximum amplitude values began in the normal range within the first 12-hour interval after injury, increased linearly, and crossed into the hypercoagulable range at 48 hours (15.1 ± 1.9 Kd/cs and 57.6 ± 1.6 mm, respectively; P <.01, analysis of variance). Conclusions Patients sustaining blunt abdominal solid organ injuries transition to a hypercoagulable state approximately 48 hours after injury. In the absence of contraindications, pharmacoprophylaxis should be considered before this time for effective venous thromboembolism prevention.
AB - Background The optimal time to initiate venous thromboembolism pharmacoprophylaxis after blunt abdominal solid organ injury is unknown. Methods Postinjury coagulation status was characterized using thromboelastography (TEG) in trauma patients with blunt abdominal solid organ injuries; TEG was divided into 12-hour intervals up to 72 hours. Results Forty-two of 304 patients (13.8%) identified underwent multiple postinjury thromboelastographic studies. Age (P =.45), gender (P =.45), and solid organ injury grade (P =.71) were similar between TEG and non-TEG patients. TEG patients had higher Injury Severity Scores compared with non-TEG patients (33.2 vs 18.3, respectively, P <.01). Among the TEG patients, the shear elastic modulus strength and maximum amplitude values began in the normal range within the first 12-hour interval after injury, increased linearly, and crossed into the hypercoagulable range at 48 hours (15.1 ± 1.9 Kd/cs and 57.6 ± 1.6 mm, respectively; P <.01, analysis of variance). Conclusions Patients sustaining blunt abdominal solid organ injuries transition to a hypercoagulable state approximately 48 hours after injury. In the absence of contraindications, pharmacoprophylaxis should be considered before this time for effective venous thromboembolism prevention.
KW - Blunt solid organ injury
KW - Hypercoagulable
KW - Trauma
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U2 - 10.1016/j.amjsurg.2013.07.024
DO - 10.1016/j.amjsurg.2013.07.024
M3 - Article
C2 - 24112665
AN - SCOPUS:84889047789
VL - 206
SP - 917
EP - 923
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 6
ER -