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03-01-2024 | Vascular Trauma | Original Article

Study to Evaluate the Role of Systemic Postoperative Anticoagulation Therapy in Patients Undergoing Medium-Sized Peripheral Artery Repair Following Trauma: a Randomized Controlled Trial

Authors: Abhishek Jaiswal, Joses Dany James, Dinesh Bagaria, Narendra Choudhary, Abhinav Kumar, Mohit Joshi, Pratyusha Priyadarshini, Atin Kumar, Shivanand Gamanagatti, Subodh Kumar, Amit Gupta, Biplab Mishra, Sushma Sagar

Published in: Indian Journal of Surgery | Issue 5/2024

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Abstract

The aim of this study is to compare outcomes of patients with and without use of systemic post-operative anti-coagulation (SPAC) having undergone end to end medium-sized arterial repair following trauma. A prospective, single-blinded, pilot randomized control trial was conducted at a level 1 trauma center from April 2019 through August 2020. Patients between 14 and 65 years having medium size vessel injury and undergoing end to end arterial repair were included. Patients were randomized into two groups—SPAC and no SPAC. Primary outcome measure was vessel patency measured clinically and/or by Doppler at 48 h and at the time of discharge. Secondary outcome measures included post-operative bleeding, re-exploration, ongoing blood product transfusion, limb salvage, duration of ICU stay, and hospital stay. A total of 32 patients were randomized. There was no difference in vessel patency at 48 h. (93.7% vs. 93.7%, p value 0.572) or at discharge (93.7% vs. 87.5%, p value 0.654). Incidence of post-operative hemorrhage (5 patients vs. 0, p value 0.030), need for additional vascular procedures (37.5% vs. 18.75, p value 0.030), need for further post-operative transfusions (50% vs. 12.5%, p value 0.040), and additional operative procedures (30 vs. 18, p value 0.024) were more in the SPAC group. There was no difference in limb salvage rates (93.7% vs. 87.5%, p value 0.513), rates of fasciotomy (68% vs. 56.3%, p value 0.412), hospital stay (mean 20.12 vs. 16.28 days, p value 0.663), and ICU stay (mean 0.81 vs. 2.7 days, p value 0.358). SPAC does not seem to improve post-operative vessel patency following end to end arterial repair of injured medium-sized vessels. An increase in adverse events following use of SPAC was noted. An adequately powered randomized trial is needed to conclusively bridge the lacunae on the use of anticoagulation in these groups of patients. Trial Registry: ctri.nic.in/clinical trials/login.php, number REF/2019/04/018649 dated 18/04/2019
Literature
3.
go back to reference Mattox KL, Feliciano DV, Burch J, Beall AC Jr, Jordan GL Jr, De Bakey ME (1989) Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Epidemiologic evolution 1958 to 1987. Ann Surg 209(6):698CrossRefPubMedPubMedCentral Mattox KL, Feliciano DV, Burch J, Beall AC Jr, Jordan GL Jr, De Bakey ME (1989) Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Epidemiologic evolution 1958 to 1987. Ann Surg 209(6):698CrossRefPubMedPubMedCentral
4.
go back to reference Oller DW, Rutledge R, Clancy T, Cunningham P, Thomason M, Meredith W et al (1992) Vascular injuries in a rural state: a review of 978 patients from a state trauma registry. J Trauma Acute Care Surg 32(6):740–746CrossRef Oller DW, Rutledge R, Clancy T, Cunningham P, Thomason M, Meredith W et al (1992) Vascular injuries in a rural state: a review of 978 patients from a state trauma registry. J Trauma Acute Care Surg 32(6):740–746CrossRef
5.
go back to reference Franz RW, Skytta CK, Shah KJ, Hartman JF, Wright ML (2012) A five-year review of management of upper-extremity arterial injuries at an urban level I trauma center. Ann Vasc Surg 26(5):655–664CrossRefPubMed Franz RW, Skytta CK, Shah KJ, Hartman JF, Wright ML (2012) A five-year review of management of upper-extremity arterial injuries at an urban level I trauma center. Ann Vasc Surg 26(5):655–664CrossRefPubMed
6.
go back to reference Mavrogenis AF, Panagopoulos GN, Kokkalis ZT, Koulouvaris P, Megaloikonomos PD, Igoumenou V et al (2016) Vascular injury in orthopedic trauma. Orthopedics. 39(4):249–259CrossRefPubMed Mavrogenis AF, Panagopoulos GN, Kokkalis ZT, Koulouvaris P, Megaloikonomos PD, Igoumenou V et al (2016) Vascular injury in orthopedic trauma. Orthopedics. 39(4):249–259CrossRefPubMed
7.
go back to reference Dente CJ, Feliciano DV (2005) Alexis carrel (1873-1944): nobel laureate, 1912. Arch Surg 140(6):609–610CrossRefPubMed Dente CJ, Feliciano DV (2005) Alexis carrel (1873-1944): nobel laureate, 1912. Arch Surg 140(6):609–610CrossRefPubMed
8.
go back to reference Howell WH, Holt E (1918) Two new factors in blood coagulation—heparin and pro-antithrombin. Am J Physiol-Legacy Content 47(3):328–341 Howell WH, Holt E (1918) Two new factors in blood coagulation—heparin and pro-antithrombin. Am J Physiol-Legacy Content 47(3):328–341
9.
go back to reference Murray G (1940) Heparin in surgical treatment of blood vessels. Arch Surg 40(2):307–325CrossRef Murray G (1940) Heparin in surgical treatment of blood vessels. Arch Surg 40(2):307–325CrossRef
10.
go back to reference Melton S, Croce MA, Patton J, Pritchard EF, Minard G, Kudsk K et al (1997) Popliteal artery trauma systemic anticoagulation and limb salvage. Ann Surg 225(5):518–527CrossRefPubMedPubMedCentral Melton S, Croce MA, Patton J, Pritchard EF, Minard G, Kudsk K et al (1997) Popliteal artery trauma systemic anticoagulation and limb salvage. Ann Surg 225(5):518–527CrossRefPubMedPubMedCentral
11.
go back to reference Keen RR, Meyer JP, Durham JR, Eldrup-Jorgensen J, Flanigan DP, Schwarcz TH et al (1991) Autogenous vein graft repair of injured extremity arteries: early and late results with 134 consecutive patients. J Vasc Surg 13(5):664–668CrossRefPubMed Keen RR, Meyer JP, Durham JR, Eldrup-Jorgensen J, Flanigan DP, Schwarcz TH et al (1991) Autogenous vein graft repair of injured extremity arteries: early and late results with 134 consecutive patients. J Vasc Surg 13(5):664–668CrossRefPubMed
13.
go back to reference Wang E, Inaba K, Cho J, Byerly S, Rowe V, Benjamin E et al (2016) Do antiplatelet and anticoagulation agents matter after repair of traumatic arterial injuries? Am Surg 82(10):968–972CrossRefPubMed Wang E, Inaba K, Cho J, Byerly S, Rowe V, Benjamin E et al (2016) Do antiplatelet and anticoagulation agents matter after repair of traumatic arterial injuries? Am Surg 82(10):968–972CrossRefPubMed
14.
go back to reference Ratnayake A, Samarasinghe B, Bala M (2014) Outcomes of popliteal vascular injuries at Sri Lankan war-front military hospital: case series of 44 cases. Injury. 45(5):879–884CrossRefPubMed Ratnayake A, Samarasinghe B, Bala M (2014) Outcomes of popliteal vascular injuries at Sri Lankan war-front military hospital: case series of 44 cases. Injury. 45(5):879–884CrossRefPubMed
15.
go back to reference Branco BC, Boutrous ML, DuBose JJ, Leake SS, Charlton-Ouw K, Rhee P et al (2016) Outcome comparison between open and endovascular management of axillosubclavian arterial injuries. J Vasc Surg 63(3):702–709CrossRefPubMed Branco BC, Boutrous ML, DuBose JJ, Leake SS, Charlton-Ouw K, Rhee P et al (2016) Outcome comparison between open and endovascular management of axillosubclavian arterial injuries. J Vasc Surg 63(3):702–709CrossRefPubMed
16.
go back to reference Riesenman PJ, Brooks JD, Farber MA (2012) Acute blunt traumatic injury to the descending thoracic aorta. J Vasc Surg 56(5):1274–1280CrossRefPubMed Riesenman PJ, Brooks JD, Farber MA (2012) Acute blunt traumatic injury to the descending thoracic aorta. J Vasc Surg 56(5):1274–1280CrossRefPubMed
17.
go back to reference Moussa O, Jonker L, Joseph T (2011) Marked variation in venous thromboprophylaxis management for abdominal aortic aneurysm repair; results of survey amongst vascular surgeons in the United Kingdom. Eur J Vasc Endovasc Surg 42(5):591–595CrossRefPubMed Moussa O, Jonker L, Joseph T (2011) Marked variation in venous thromboprophylaxis management for abdominal aortic aneurysm repair; results of survey amongst vascular surgeons in the United Kingdom. Eur J Vasc Endovasc Surg 42(5):591–595CrossRefPubMed
18.
go back to reference Fox N, Rajani RR, Bokhari F, Chiu WC, Kerwin A, Seamon MJ et al (2012) Evaluation and management of penetrating lower extremity arterial trauma: an eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg 73(5 SUPPL.4):315–320CrossRef Fox N, Rajani RR, Bokhari F, Chiu WC, Kerwin A, Seamon MJ et al (2012) Evaluation and management of penetrating lower extremity arterial trauma: an eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg 73(5 SUPPL.4):315–320CrossRef
19.
go back to reference Casale GP, Pipinos II (2014) Ischemia-reperfusion. Rutherford’s Vasc Surgery, 8th edn. Elsevier, China, pp 87–98 Casale GP, Pipinos II (2014) Ischemia-reperfusion. Rutherford’s Vasc Surgery, 8th edn. Elsevier, China, pp 87–98
20.
go back to reference Snyder WH (1982) Vascular injuries near the knee: an updated series and overview of the problem. Surgery. 91(5):502–506PubMed Snyder WH (1982) Vascular injuries near the knee: an updated series and overview of the problem. Surgery. 91(5):502–506PubMed
22.
go back to reference Guerrero A, Gibson K, Kralovich KA, Pipinos I, Agnostopolous P, Carter Y et al (2002) Limb loss following lower extremity arterial trauma: what can be done proactively? Injury. 33(9):765–769CrossRefPubMed Guerrero A, Gibson K, Kralovich KA, Pipinos I, Agnostopolous P, Carter Y et al (2002) Limb loss following lower extremity arterial trauma: what can be done proactively? Injury. 33(9):765–769CrossRefPubMed
23.
24.
go back to reference Wagner WH, Calkins ER, Weaver FA, Goodwin JA, Myles RA, Yellin AE (1988) Blunt popliteal artery trauma: one hundred consecutive injuries. J Vasc Surg 7(5):736–748CrossRefPubMed Wagner WH, Calkins ER, Weaver FA, Goodwin JA, Myles RA, Yellin AE (1988) Blunt popliteal artery trauma: one hundred consecutive injuries. J Vasc Surg 7(5):736–748CrossRefPubMed
25.
go back to reference Lim LT, Michuda MS, Flanigan DP, Pankovich A (1980) Popliteal artery trauma: 31 consecutive cases without amputation. Arch Surg 115(11):1307–1313CrossRefPubMed Lim LT, Michuda MS, Flanigan DP, Pankovich A (1980) Popliteal artery trauma: 31 consecutive cases without amputation. Arch Surg 115(11):1307–1313CrossRefPubMed
26.
go back to reference Melton SM, Croce MA, Patton JH Jr, Pritchard FE, Minard G, Kudsk KA et al (1997) Popliteal artery trauma. Systemic anticoagulation and intraoperative thrombolysis improves limb salvage. Ann Surg 225(5):518CrossRefPubMedPubMedCentral Melton SM, Croce MA, Patton JH Jr, Pritchard FE, Minard G, Kudsk KA et al (1997) Popliteal artery trauma. Systemic anticoagulation and intraoperative thrombolysis improves limb salvage. Ann Surg 225(5):518CrossRefPubMedPubMedCentral
27.
go back to reference Humphries M, Blume MK, Rodriguez MC, DuBose JJ, Galante JM (2016) Outcomes after anticoagulation for traumatic arterial injuries of the extremity. JAMA Surg 151(10):986–987CrossRefPubMed Humphries M, Blume MK, Rodriguez MC, DuBose JJ, Galante JM (2016) Outcomes after anticoagulation for traumatic arterial injuries of the extremity. JAMA Surg 151(10):986–987CrossRefPubMed
28.
go back to reference Fabian TC, Patton JH Jr, Croce MA, Minard G, Kudsk KA, Pritchard FE (1996) Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. Ann Surg 223(5):513CrossRefPubMedPubMedCentral Fabian TC, Patton JH Jr, Croce MA, Minard G, Kudsk KA, Pritchard FE (1996) Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. Ann Surg 223(5):513CrossRefPubMedPubMedCentral
29.
go back to reference Hafez HM, Woolgar J, Robbs JV (2001) Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg 33(6):1212–1219CrossRefPubMed Hafez HM, Woolgar J, Robbs JV (2001) Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg 33(6):1212–1219CrossRefPubMed
30.
go back to reference DuBose JJ, Savage SA, Fabian TC, Menaker J, Scalea T, Holcomb JB et al (2015) The American association for the surgery of trauma prospective observational vascular injury treatment (PROOVIT) registry: multicenter data on modern vascular injury diagnosis, management, and outcomes. J Trauma Acute Care Surg 78(2):215–223CrossRefPubMed DuBose JJ, Savage SA, Fabian TC, Menaker J, Scalea T, Holcomb JB et al (2015) The American association for the surgery of trauma prospective observational vascular injury treatment (PROOVIT) registry: multicenter data on modern vascular injury diagnosis, management, and outcomes. J Trauma Acute Care Surg 78(2):215–223CrossRefPubMed
31.
go back to reference Loja MN, Galante JM, Humphries M, Savage S, Fabian T, Scalea T et al (2017) Systemic anticoagulation in the setting of vascular extremity trauma. Injury. 48(9):1911–1916CrossRefPubMed Loja MN, Galante JM, Humphries M, Savage S, Fabian T, Scalea T et al (2017) Systemic anticoagulation in the setting of vascular extremity trauma. Injury. 48(9):1911–1916CrossRefPubMed
Metadata
Title
Study to Evaluate the Role of Systemic Postoperative Anticoagulation Therapy in Patients Undergoing Medium-Sized Peripheral Artery Repair Following Trauma: a Randomized Controlled Trial
Authors
Abhishek Jaiswal
Joses Dany James
Dinesh Bagaria
Narendra Choudhary
Abhinav Kumar
Mohit Joshi
Pratyusha Priyadarshini
Atin Kumar
Shivanand Gamanagatti
Subodh Kumar
Amit Gupta
Biplab Mishra
Sushma Sagar
Publication date
03-01-2024
Publisher
Springer India
Keyword
Vascular Trauma
Published in
Indian Journal of Surgery / Issue 5/2024
Print ISSN: 0972-2068
Electronic ISSN: 0973-9793
DOI
https://doi.org/10.1007/s12262-023-04007-4
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