Hypercoagulability following blunt solid abdominal organ injury: When to initiate anticoagulation

Brandon C. Chapman, Ernest E. Moore, Carlton Barnett, Robert T. Stovall, Walter L. Biffl, Clay C. Burlew, Denis D. Bensard, Gregory Jurkovich, Fredric M. Pieracci

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)917-923
Number of pages7
JournalAmerican Journal of Surgery
Volume206
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

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Keywords

  • Blunt solid organ injury
  • Hypercoagulable
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Chapman, B. C., Moore, E. E., Barnett, C., Stovall, R. T., Biffl, W. L., Burlew, C. C., Bensard, D. D., Jurkovich, G., & Pieracci, F. M. (2013). Hypercoagulability following blunt solid abdominal organ injury: When to initiate anticoagulation. American Journal of Surgery, 206(6), 917-923. https://doi.org/10.1016/j.amjsurg.2013.07.024