WTP4.17 Early Chemical Thromboprophylaxis in Non-Operatively Managed Blunt Traumatic Solid Organ Injury: Balancing Risk and Benefit

Aims Early initiation of chemical thromboprophylaxis in patients admitted with blunt traumatic solid organ injury which has been non-operatively managed can provide challenging decision making when balancing risk of post-injury venous thromboembolic events (VTE) with potential haemorrhagic complications. This review was to determine if early VTE prophylaxis was associated with increased risk of failure of non-operative management of these injuries, with secondary outcome assessing risk of incidence of VTE. Methods Literature review of studies reporting outcomes of traumatic blunt solid organ injury (including splenic, hepatic and renal) without associated traumatic brain injury, with early initiation of chemical thromboprophylaxis in first 48 hours of admission compared to late administration >48hrs after admission. Meta-analysis conducted using statistical software Jamovi (Version 2.5). Results 11 retrospective studies and 2 prospective studies with total 8,634 patients included. In the random effects model analysis, no significant difference was demonstrated in failure of non-operative management for patients with early administration of thromboprophylaxis compared to late administration with no significant heterogeneity (OR -0.0222 (95% Cl: -0.343 to 0.298), Z=-0.136, p=0.892). There was a significant difference in VTE outcomes (OR -0.724 (95% Cl: -1.054 to -0.394), Z= -4.30, p<0.001). Conclusion Evidence suggests initiation of chemical thromboprophylaxis within 48 hours of admission in patients with blunt solid organ injury managed non-operatively is safe and does not result in increased risk of operative intervention but does however, significantly reduce the risk of complicating VTE.