Timing of VTE Chemoprophylaxis With Major Orthopedic Surgery of Traumatic Femoral and Tibial Fractures
Back to course
Video Transcription
Video Summary
Asset Subtitle
Pharmacology, Trauma, Cardiovascular, 2022
Asset Caption
INTRODUCTION: Lower-extremity fractures represent 40% of traumatic injuries and are considered in the highest-risk group for developing a venous thromboembolism (VTE). Debate surrounds which operations are safe to continue VTE chemoprophylaxis without interruption. The study objective was to determine the safety and efficacy of perioperative administration of VTE chemoprophylaxis in patients with major orthopedic surgery. METHODS: This multicenter, retrospective cohort study included 880 adults with femoral or tibial fractures admitted between 1/1/2018 and 3/1/2020 to six trauma centers. Exclusions were head or spinal injury (AIS ≥2), pre-injury chronic anticoagulation, or no administration of LMWH or UFH for VTE chemoprophylaxis. Perioperative administration was defined as initiation preoperatively without interruption for surgery, or initiation within 12 hours postoperatively. The primary outcome was incidence of clinically significant postoperative hemorrhage (CSH), defined as overt hemorrhage resulting in blood transfusion, wound dehiscence, compartment syndrome, return to OR, or ≥2g/dl decrease in hemoglobin. Mixed repeated measures models evaluated differences in CSH based on perioperative therapy. RESULTS: There were 925 long bone surgeries. Of these, 48% (n=443) had perioperative therapy (n=222 initiated within 12h postop, n=221 not held for surgery). The remaining 52% of surgeries did not receive perioperative therapy (initiated > 12h postop, n=466; interrupted, n=15; discontinued postop, n=1). There were 176 patients with 185 CSH, nearly all resulting in ≥2g/dl drop in hemoglobin requiring blood transfusion (96%). The incidence of CSH was similar based on perioperative therapy or not (21% vs. 19%, p=0.64). After adjustment, there were similar odds of CSH by perioperative therapy (p=0.67). Covariates significantly associated with CSH were age ≥65y, GCS < 15, female sex, total hours in surgery, and pre-injury antiplatelet use. The incidence of VTEs were similar with perioperative therapy or not (1.1% vs. 1.9%, p=0.36). However, VTEs were more frequent when chemoprophylaxis was interrupted (4.4% vs. 0.2%, p < 0.001), as were CSH (33.7% vs. 14.4%, p < 0.001). CONCLUSIONS: These data suggest early and continuous VTE chemoprophylaxis is safe and effective with major orthopedic surgery for long bone fractures.
Meta Tag
Content Type Presentation
Knowledge Area Pharmacology
Knowledge Area Trauma
Knowledge Area Cardiovascular
Knowledge Level Advanced
Membership Level Select
Tag Anticoagulation
Tag Thromboembolism
Tag Burns
Tag Hemorrhage
Year 2022
venous thromboembolism
lower extremity long bone fractures
perioperative administration
bleeding risk


Society of Critical Care Medicine

500 Midway Drive
Mount Prospect, IL 60056 USA

Phone: +1 847 827-6888
Fax: +1 847 439-7226
Email: support@sccm.org

Contact Us

About SCCM


Advertising & Sponsorship




Patients & Families

Surviving Sepsis Campaign

Critical Care Societies Collaborative

kisspng-facebook-social-media-computer-icons-linkedin-soci-gray-5ac493cf1c2975.7867418415228323351154  - KW Symphony    Gray twitter 3 icon - Free gray social icons    Gray linkedin 3 icon - Free gray site logo icons    Gray instagram icon - Free gray social icons    YouTube Icon Gray Box - HONOR VETERANS NOW


© Society of Critical Care Medicine. All rights reserved.   |    Privacy Statement    |    Terms & Conditions
The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.

Android App Download IOS App Download Powered By