Bleeding Manifestations after Early Use of Low-Molecular-Weight Heparins in Blunt Splenic Injuries

Abstract

Low-molecular-weight heparins (LMWHs) have emerged as an effective method for deep venous thrombosis (DVT) prophylaxis after major trauma. The early use of LMWH in patients with splenic injuries may result in increased rates of blood transfusions and failure of nonoperative management. A retrospective review of the records of all patients > or = 18 years old that sustained blunt splenic injuries from April 2000 to July 2002 was performed. Patients were divided in two groups based on whether they received LMWH during the first 48 hours (early group) or not (late group). A total of 188 patients were evaluated. One hundred fourteen patients had their splenic injuries managed nonoperatively and were included in the study. Fifty patients were assigned to the early group and 64 to the late group. There was no statistical difference between groups regarding basic demographic data, initial laboratory results, and severity of their splenic injuries. In the early group, two (4%) patients failed nonoperative management compared with four (6%) patients in the late group (P = 0.593). The number of patients requiring blood transfusions within the first 5 days after admission was 25 (50.0%) in the early group and 36 (56.2%) in the late group (P = 0.507). The average number of blood units given per patient within the first 5 days after admission were 3.2 +/- 1.5 in the early group and 3.0 +/- 1.8 in the late group (P = 0.782). This study suggests that the early use of LMWH in trauma patients with splenic injuries is not associated with an increased rate of blood transfusion requirements or an increased rate of failure of nonoperative management.