PMID- 36203031 OWN - NLM STAT- MEDLINE DCOM- 20230215 LR - 20230215 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 49 IP - 1 DP - 2023 Feb TI - Timing and choice of systemic anticoagulation in the setting of extremity arterial injury repair. PG - 473-485 LID - 10.1007/s00068-022-02092-w [doi] AB - PURPOSE: The role of perioperative anticoagulation in the setting of peripheral arterial injury remains unclear. We hypothesized that early initiation of anticoagulation is associated with a reduced amputation rate without increasing bleeding complications. METHODS: Using the 2016-2019 ACS-TQIP database, adult patients with upper and lower extremity vascular injuries who underwent open arterial repair and received anticoagulation were included. Patients were divided into two groups: (1) early venous thromboembolism prophylaxis ( 24 h) following arterial repair. The primary outcomes were the rates of limb amputation and bleeding complications. Multivariable logistic regression was used to estimate the impact of timing and type of anticoagulation on the rates of limb amputation and bleeding complications. RESULTS: 4379 patients were included, and 83.9% were males. 68.1% of patients received early anticoagulation, whereas 31.9% received late thromboprophylaxis. Low-molecular-weight heparin (LMWH) was used in 62.0% of patients, and unfractionated heparin (UFH) was administered in 34.3% of patients. Multivariable analysis showed that late initiation of thromboprophylaxis (OR = 1.69 [1.16-2.45], p = 0.006) and use of UFH (OR = 2.61 [1.80-3.79], p < 0.001) were associated with increased rate of amputation. Early initiation of anticoagulation (OR = 2.16 [1.63-2.85], p < 0.001) was associated with increased risk of bleeding complications requiring blood transfusions. Similarly, the use of UFH was associated with a higher rate of bleeding events compared to LWMH (OR = 2.61, [1.80-3.79], p < 0.001). CONCLUSION: Patients with the operative repair of arterial injuries receiving early perioperative anticoagulation demonstrated an improved limb salvage outcome than those who received late thromboprophylaxis. Our data also suggest that early initiation of prophylaxis may be associated with increased bleeding risk, which may be attenuated using LMWH compared to UFH. CI - (c) 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany. FAU - Argandykov, Dias AU - Argandykov D AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. FAU - Proano-Zamudio, Jefferson A AU - Proano-Zamudio JA AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. FAU - Dorken-Gallastegi, Ander AU - Dorken-Gallastegi A AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. FAU - Gebran, Anthony AU - Gebran A AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. FAU - Renne, Angela M AU - Renne AM AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. FAU - Paranjape, Charudutt N AU - Paranjape CN AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. FAU - King, David R AU - King DR AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. FAU - Kaafarani, Haytham M A AU - Kaafarani HMA AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. FAU - Velmahos, George C AU - Velmahos GC AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. FAU - Hwabejire, John O AU - Hwabejire JO AUID- ORCID: 0000-0003-0759-2638 AD - Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA. jhwabejire@partners.org. LA - eng PT - Journal Article DEP - 20221006 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 RN - 9005-49-6 (Heparin) RN - 0 (Anticoagulants) RN - 0 (Heparin, Low-Molecular-Weight) SB - IM MH - Male MH - Adult MH - Humans MH - Female MH - Heparin/therapeutic use MH - Anticoagulants/therapeutic use MH - Heparin, Low-Molecular-Weight/therapeutic use MH - *Vascular System Injuries/complications MH - *Venous Thromboembolism/prevention & control/etiology MH - Hemorrhage/complications MH - Extremities OTO - NOTNLM OT - Amputation OT - Arterial injury OT - Bleeding OT - VTE anticoagulation EDAT- 2022/10/07 06:00 MHDA- 2023/02/16 06:00 CRDT- 2022/10/06 23:36 PHST- 2022/05/20 00:00 [received] PHST- 2022/08/16 00:00 [accepted] PHST- 2022/10/07 06:00 [pubmed] PHST- 2023/02/16 06:00 [medline] PHST- 2022/10/06 23:36 [entrez] AID - 10.1007/s00068-022-02092-w [pii] AID - 10.1007/s00068-022-02092-w [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2023 Feb;49(1):473-485. doi: 10.1007/s00068-022-02092-w. Epub 2022 Oct 6.