Abstract：
Trauma patients with blunt abdominal solid organ injuries are at high risk for venous thromboembolism (VTE), but the optimal time to safely administer chemical thromboprophylaxis is controversial, especially for patients who are managed nonoperatively due to increased risk of hemorrhage. We sought to compare failure of nonoperative management (NOM) and VTE events based on timing of chemical thromboprophylaxis initiation.
A systematic review was conducted in PubMed and Embase databases. Studies were included if they evaluated timing of initiation of chemical thromboprophylaxis in trauma patients who underwent NOM of blunt solid organ injuries. Outcomes included failure of NOM and incidence of VTE. A random-effects meta-analysis was performed comparing patients who received late (>48 h) versus early thromboprophylaxis initiation.
Twelve retrospective cohort studies, comprising 21,909 patients, were included. Three studies, including 6375 patients, provided data on adjusted outcomes. Pooled adjusted analysis demonstrated no difference in failure of NOM in patients receiving late versus early thromboprophylaxis (odds ratio [OR] 0.92, 95% confidence interval [CI]:0.4-2.14). When including all unadjusted studies, even those at high risk of bias, there remained no difference in failure of NOM (OR 1.16, 95% CI:0.72-1.86). In the adjusted analysis for VTE events, which had 6259 patients between two studies, patients receiving late chemical thromboprophylaxis had a higher risk of VTE compared with those who received early thromboprophylaxis (OR 1.89, 95% CI:1.15-3.12).
Based on current observational evidence, initiation of prophylaxis before 48 h is associated with lower VTE rates without higher risk of failure of NOM.
A systematic review was conducted in PubMed and Embase databases. Studies were included if they evaluated timing of initiation of chemical thromboprophylaxis in trauma patients who underwent NOM of blunt solid organ injuries. Outcomes included failure of NOM and incidence of VTE. A random-effects meta-analysis was performed comparing patients who received late (>48 h) versus early thromboprophylaxis initiation.
Twelve retrospective cohort studies, comprising 21,909 patients, were included. Three studies, including 6375 patients, provided data on adjusted outcomes. Pooled adjusted analysis demonstrated no difference in failure of NOM in patients receiving late versus early thromboprophylaxis (odds ratio [OR] 0.92, 95% confidence interval [CI]:0.4-2.14). When including all unadjusted studies, even those at high risk of bias, there remained no difference in failure of NOM (OR 1.16, 95% CI:0.72-1.86). In the adjusted analysis for VTE events, which had 6259 patients between two studies, patients receiving late chemical thromboprophylaxis had a higher risk of VTE compared with those who received early thromboprophylaxis (OR 1.89, 95% CI:1.15-3.12).
Based on current observational evidence, initiation of prophylaxis before 48 h is associated with lower VTE rates without higher risk of failure of NOM.
摘要：
闭合性腹部实体器官损伤的创伤患者是静脉血栓栓塞（VTE）的高风险，但是安全实施化学血栓预防的最佳时间是有争议的，尤其是对于因出血风险增加而非手术治疗的患者.我们试图根据化学血栓预防的时机比较非手术治疗失败（NOM）和VTE事件。
在PubMed和Embase数据库中进行了系统评价。如果他们评估了接受钝性实体器官损伤NOM的创伤患者开始化学血栓预防的时机，则包括研究。结果包括NOM失败和VTE的发生率。进行了随机效应荟萃分析，比较了接受晚期（>48h）与早期血栓预防的患者。
12项回顾性队列研究，包括21,909名患者，包括在内。三项研究,包括6375名患者，提供了调整后结果的数据。汇总调整分析显示，接受晚期和早期血栓预防的患者NOM失败没有差异（比值比[OR]0.92，95％置信区间[CI]：0.4-2.14）。当包括所有未调整的研究时，即使是那些有偏见风险的人，NOM失败无差异(OR1.16,95%CI:0.72-1.86)。在VTE事件的调整分析中，在两项研究中有6259名患者，与接受早期血栓预防的患者相比,接受晚期化学血栓预防的患者发生VTE的风险更高(OR1.89,95%CI:1.15~3.12).
根据目前的观察证据，在48h前开始预防与较低的VTE率相关,而NOM失败的风险较高.
在PubMed和Embase数据库中进行了系统评价。
12项回顾性队列研究，
根据目前的观察证据，
