Systemic anticoagulation in the setting of vascular extremity trauma

Abstract

In this multicenter prospective cohort, intraoperative systemic anticoagulation was not associated with a difference in rate of repair thrombosis or limb loss; but was associated with an increase in blood product requirements and prolonged hospital stay. Our data suggest there is no significant difference in outcome to support use of ISA for repair of traumatic arterial injuries.

A meta-analysis on anticoagulation after vascular trauma

“…Similarly, Guerrero et al and Maher et al showed anticoagulation improved limb salvage in patients who present with arterial injuries in the common iliac and popliteal arteries who then underwent operative intervention [21,25]. Furthermore, patients who were administered ISA had a decreased return to the [26] ISA and post operative VTE No distinction Maher et al [27] ISA Arterial patency Upper and lower Humphries et al [29] ISA Amputation and repair failure No distinction Wang et al [24] ISA/ILA and post operative Amputation, arterial patency, VTE No distinction Guerrero et al [23] ISA/recovery room Amputation Lower Melton et al [25] ISA Amputation Lower Wagner et al [22] ISA Amputation Lower operating theatre for post-operative bleeding and were significantly more likely to maintain arterial patency, in addition to requiring a shorter Intensive Care Unit and overall stay in the hospital [25]. Conversely, ISA in patients with major vascular injury of the neck, torso or proximal upper (to the elbow), and lower (to the knee) extremities was shown to reduce the incidence of VTE and subsequent post-operative addition of enoxaparin prophylaxis also reduced VTE incidence [24].…”

“…Moreover, the studies looked at a range of different locations that were affected by the trauma. There were 4 studies that exclusively looked at lower limb trauma [20][21][22][23] whilst 3 looked at both upper and lower [24][25][26]. However, one study did not make clear distinctions between anatomical locations of the traumatic insult [27].…”

“…Notably, there were no identifiable studies on the effect of solely administering anti-platelet therapy on the outcomes of vascular trauma surgery. Seven studies reported the use of anticoagulation alone in patients with vascular trauma [20,21,[23][24][25][26][27] and one study reported the effects of anticoagulation and antiplatelet (aspirin) therapy in this context [22]. No studies looking at the use of anti-platelets alone were found.…”

“…No studies looking at the use of anti-platelets alone were found. Moreover, there was only one study assessing outcomes following post-operative anticoagulation [22], and one study evaluated the use of perioperative anticoagulation [20], whilst 6 studies assessed the prognosis of intraoperative anticoagulation [21,[23][24][25][26][27].…”

“…Four studies [22,23,26,27] reported no statistically significant difference in outcomes with the use of anticoagulants in patients with vascular trauma, and thus do not routinely recommend anticoagulation therapy. These studies also retrospectively analysed outcomes.…”