时间是一切:在重大创伤后早期启动VTE预防是有效和安全的
Andrew J Kerwin1, Saskya Byerly1, Dina M Filiberto1
1Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science Center, Memphis, TN.
Annals of surgery
|June 10, 2025
概括
在重大创伤患者的早期药理性静脉血栓塞栓症 (VTE) 预防显著降低了42%,而不会增加出血并发症. 这种早期启动应该成为风险患者的标准护理.
科学领域:
- 创伤护理的护理人员.
- 这是血管外科手术.
- 紧急医疗 紧急医疗
背景情况:
- 药物治疗静脉血栓塞栓症 (VTE) 预防对于严重创伤患者至关重要.
- 有关早期启动VTE预防的潜在出血并发症存在担忧.
- 在入院后24小时内启动VTE预防的安全性和有效性仍在调查中.
研究的目的:
- 评估在重创患者入院后24小时内启动药理性VTE预防的疗效和安全性.
- 为了比较早期 (≤24小时) 与晚期 (>24小时) VTE 预防的患者之间的结果.
- 在重大创伤患者中识别VTE的预测因素.
主要方法:
- 对重创患者的回顾性分析,按VTE预防开始的时间分层 (≤24小时 vs>24小时).
- 群体之间的静脉瘤发病率,静脉瘤类型 (深静脉血栓,肺栓塞),出血并发症和死亡率的比较.
- 应用通用线性混合模型 (GLMM) 来确定VTE的预测因子.
主要成果:
- 早期预防组 (3369名患者) 与晚期组 (3200名患者,7.8%;P <0.001) 相比,VTE发病率显著降低 (2.8%).
- 晚期组表现出更高的内出血发病率 (0.5%对0.2%;P=0.009) 和增加的死亡率 (1.8%对0.6%;P<0.001).
- GLMM分析表明,早期VTE预防与VTE风险降低有关 (OR:0.58;P <0.001).
结论:
- 在重创患者入院后24小时内开始药理性VTE预防,导致VTE风险降低42%.
- 早期的静脉瘤预防不增加出血并发症的风险.
- 早期VTE预防应被视为主要创伤患者的标准护理,包括创伤性脑损伤患者.
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