Impact of Systemic Anticoagulation During Traumatic Peripheral Arterial Repair on Re-Intervention and Amputation: An Analysis of 11 Years of PROOVIT Data

Introduction Systemic anticoagulation (SAC) is widely used during peripheral arterial repair (PAR) to mitigate thrombotic risks, but its efficacy in trauma patients remains unclear. This study evaluated the association of SAC with re-intervention and amputation rates in traumatic PAR. Methods This retrospective study queried the Prospective Observational Vascular Injury Treatment (PROOVIT) database (2012-2023) for traumatic PAR cases. Patients were grouped by SAC use during repair. Outcomes included re-intervention, amputation, thrombotic complications, packed red blood cell (PRBC) transfusion within 24 hours, and length of stay (LOS). Multivariable analysis adjusted for age, sex, injury mechanism, Injury Severity Score (ISS), and mangled extremity severity score (MESS). Results Of 1182 cases, 713 (60%) received SAC. Median age was 30 years, and 83.6% were male. In univariable analysis, amputation rates were similar between SAC (4.8%) and no-SAC (4.7%) groups ( P = 0.970), as were thrombotic complications (4.8% vs 3.4%, P = 0.257). However, SAC was associated with higher re-intervention rates (14.4% vs 9.6%, P = 0.014), increased PRBC transfusion (median 2 vs 0 units, P < 0.001), and longer LOS (median 8 vs 5 days, P < 0.001). Multivariable analysis found no significant association between SAC and re-intervention (aOR 1.128, P = 0.643), or amputation (aOR 0.671, P = 0.200). Conclusion SAC during traumatic peripheral arterial repair did not reduce amputation rates and was associated with increased re-intervention. However, multivariable analysis revealed no significant difference in outcomes, suggesting SAC neither provides universal benefit nor introduces harm. These findings highlight the need for future research to identify specific trauma populations that may benefit from individualized SAC use. Level of Evidence Level III, Prognostic/Epidemiological.