1011 Chemical VTE Prophylaxis for Adults with Abdominal Trauma: A Systematic Review

Abstract

Abstract Aim The increased incidence of VTE following blunt and penetrating abdominal trauma is well documented due to trauma induced coagulopathy and immobility. Whilst guidance often advocates early chemical thromboprophylaxis with low molecular weight heparin, clinical practice varies. This systematic review aims to evaluate evidence regarding VTE chemical prophylaxis in the adult trauma population (16+) presenting with blunt and penetrating abdominal trauma. Method A search of MEDLINE, EMBASE and PubMed databases was conducted, and additional references were identified from a review of literature citations. Search results were limited to English language and human studies. Co-existing severe head injuries defined as AIS>3 was excluded. Data was summarised in data extraction tables, along with level of evidence and bias scores for each study. Results A total of 9 retrospective trials exploring the timings of VTE chemoprophylaxis were included. All but 3 studies showed late VTE chemoprophylaxis initiation (>48hrs) was linked with a higher incidence of VTE, with significant results in 4 studies. Early VTE chemoprophylaxis was not associated with increased risk of NOM failure. Early VTE chemoprophylaxis was also not found to be associated with an increased risk in bleeding in most studies, with non-significant differences in blood transfusion requirements. Conclusions Research favours early initiation of VTE chemoprophylaxis in the abdominal trauma population, without significant risk of complications and supports results from other trauma populations. Further prospective studies are needed in the abdominal trauma population, as well as its sub-populations, to directly compare VTE agents and dosing regimens and provide higher quality evidence to support chemical thromboprophylaxis.