Early Versus Late Venous Thromboembolism Prophylaxis Impact on Outcomes of Blunt Solid Abdominal Organ Injuries

Background: Venous thromboembolism (VTE) following solid, blunt, isolated abdominal organ injuries remains a common posttrauma complication in adults. Accordingly, gaining a better understanding of the effect of early versus late VTE prophylaxis to reduce rates of this complication is prudent. Objective: The purpose of this study is to evaluate the impact of early versus late VTE prophylaxis on clinical outcomes in adult trauma patients with isolated blunt solid abdominal organ injuries. Methods: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Program Participant Use File database between 2017 and 2021 to compare clinical outcomes between early (≤48 hours) and late (>48 hours) VTE prophylaxis, including deep vein thrombosis (DVT), pulmonary embolism (PE), and other secondary outcomes. This study included adult (age ≥ 16) trauma patients with severe (ISS > 15) and isolated Abbreviated Injury Scale (AIS) abdomen ≥ 3, all other body regions < 3, blunt American Association for the Surgery of Trauma (AAST) grade ≥ 3 solid abdominal organ injuries without traumatic brain injury (TBI) (AIS head < 2) who received early or late chemical VTE prophylaxis. Results: A total of 3,365 non-TBI patients with isolated blunt solid abdominal organ injuries, with 2,033 patients (60.4%) receiving early VTE prophylaxis and 1,332 (39.6%) receiving late prophylaxis, were included. Early prophylaxis was associated with a 57% lower risk of DVT (OR 0.4, 95% CI [0.19, 0.98], p = .044). Conclusion: Adult non-TBI trauma patients with isolated, moderate-severe, blunt solid abdominal organ injuries receiving early VTE prophylaxis have significantly lower odds of developing specifically DVT compared to patients receiving late prophylaxis.