Lower Mortality and Morbidity With Low Molecular Weight Heparin for Venous Thromboembolic Event Prophylaxis in Spine Trauma

Abstract

Abstract INTRODUCTION Up to 80% of spine trauma patients who do not receive thromboprophylaxis have a venous thromboembolic event (VTE) and pulmonary embolism (PE) is a major cause of death, yet national consensus on prophylactic regimens has not been reached. We compared the efficacy of low molecular weight heparin (LMWH) versus unfractionated heparin (UH) in decreasing poor outcomes in spine trauma patients. METHODS Isolated spine trauma cases in the American College of Surgeons Trauma Quality Improvement Program (TQIP) were queried using the Abbreviated Injury Scale (AIS). Patients who received LMWH were compared to UH on adjusted rates of in-hospital mortality, thromboembolic complications (DVT and PE), and total in-hospital complications. RESULTS UH patients had higher rates of spinal cord injury (32.26% vs 25.32%; P < .0001), altered mental status (6.26% vs 5.18%; P = .0005), hypotension on arrival (4.70% vs 4.11%; P = .03) and spinal fusions (29.52% vs 22.94%; P < .0001). LMWH patients had lower rates of mortality (OR: 0.74; 95% CI: 0.62-0.88; P = .0008), thromboembolic complications (OR: 0.75; 95% CI: 0.64-0.88; P = .0003), and total complications (OR: 0.89; 95% CI: 0.83-0.94; P = .0001). While nonfused patients had lower odds of death (OR: 0.35; 95% CI: 0.29-0.43; P < .0001), thromboembolic (OR: 0.71; 95% CI: 0.58-0.87; P = .001), and any complications (OR: 0.84; 95% CI: 0.78-0.91; P < .0001) when given LMWH, fused on LMWH had no improvement in these outcomes. CONCLUSION Spinal trauma patients who received LMWH were less likely to die, have thromboembolic complications and any complication compared to those who received UH. Further research, including randomized clinical trials, is necessary to investigate this potential benefit.