Sage Journals: Discover world-class research

Abstract

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.

Keywords

peripheral arterial injury extremity trauma outcomes vascular systemic anticoagulation amputation re-intervention

Get full access to this article

View all access options for this article.

References

Compton

Rhee

. Peripheral vascular trauma. Perspect Vasc Surg Endovasc Ther. 2005;17(4):297-307. doi:10.1177/153100350501700404

Rozycki

Tremblay

Feliciano

McClelland

. Blunt vascular trauma in the extremity: diagnosis, management, and outcome. J Trauma. 2003;55(5):814-824. doi:10.1097/01.TA.0000087807.44105.AE

Khan

Elghazaly

Mian

Khan

. A meta-analysis on anticoagulation after vascular trauma. Eur J Trauma Emerg Surg. 2020;46(6):1291-1299. doi:10.1007/s00068-020-01321-4

Lindblad

Bergqvist

Wakefield

Stanley

. Time-related anticoagulation after regional and systemic administration of heparin in patients undergoing aortoiliac surgery. Eur J Vasc Surg. 1994;8(5):574-577. doi:10.1016/s0950-821x(05)80593-6

Couteau

Rem

Guillier

Moris

Revol

Cristofari

. Improving free-flap survival using intra-operative heparin: ritualistic practice or evidence-base medicine? A systematic review. Ann Chir Plast Esthet. 2018;63(3):e1-e5. doi:10.1016/j.anplas.2017.06.010

D’Ayala

Smith

Martone

Briggs

Deitch

Wise

. The effect of systemic anticoagulation in patients undergoing angioaccess surgery. Ann Vasc Surg. 2008;22(1):11-15. doi:10.1016/j.avsg.2007.09.002

Wakefield

Lindblad

Stanley

, et al. Heparin and protamine use in peripheral vascular surgery: a comparison between surgeons of the Society for Vascular Surgery and the European Society for Vascular Surgery. Eur J Vasc Surg. 1994;8(2):193-198. doi:10.1016/s0950-821x(05)80459-1

Moore

Kornblith

, et al. Trauma-induced coagulopathy. Nat Rev Dis Primers. 2021;7(1):30. doi:10.1038/s41572-021-00264-3

Neal

Spinella

. The hemostatic resuscitation and trauma induced coagulopathy (HERETIC) meeting: challenging dogma. Trauma Surg Acute Care Open. 2024;9(Suppl 1):e001306. doi:10.1136/tsaco-2023-001306

10.

Maher

Frank

Saillant

, et al. Systemic intraoperative anticoagulation during arterial injury repair: implications for patency and bleeding. J Trauma Acute Care Surg. 2017;82(4):680-686. doi:10.1097/TA.0000000000001384

11.

Loja

Galante

Humphries

, et al. Systemic anticoagulation in the setting of vascular extremity trauma. Injury. 2017;48(9):1911-1916. doi:10.1016/j.injury.2017.03.020

12.

Stonko

Betzold

Azar

, et al. Postoperative antiplatelet and/or anticoagulation use does not impact complication or reintervention rates after vein repair of arterial injury: a PROOVIT study. Vascular. 2023;31(4):777-783. doi:10.1177/17085381221082371

13.

DuBose

Savage

Fabian

, et al. 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. 2015;78(2):215-222. doi:10.1097/TA.0000000000000520

14.

von Elm

Altman

Egger

, et al. The strengthening the reporting of observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-1499. doi:10.1016/j.ijsu.2014.07.013

15.

Thompson

Mullee

Bell

PRF

, et al. Intraoperative heparinisation, blood loss and myocardial infarction during aortic aneurysm surgery: a joint vascular research group study. Eur J Vasc Endovasc Surg. 1996;12(1):86-90. doi:10.1016/S1078-5884(96)80281-4

16.

Wagner

Calkins

Weaver

Goodwin

Myles

Yellin

. Blunt popliteal artery trauma: one hundred consecutive injuries. J Vasc Surg. 1988;7(5):736-743. doi:10.1067/mva.1988.avs0070736

17.

Melton

Croce

Patton

, et al. Popliteal artery trauma. Systemic anticoagulation and intraoperative thrombolysis improves limb salvage. Ann Surg. 1997;225(5):518-527. doi:10.1097/00000658-199705000-00009

18.

Karam

Haberman

Nguyen

, et al. Trauma surgeon-performed peripheral arterial repairs are associated with equivalent outcomes when compared with vascular surgeons. J Trauma Acute Care Surg. 2022;92(4):754-759. doi:10.1097/TA.0000000000003531

19.

Harfouche

Kauvar

Feliciano

Dubose

. Managing vascular trauma: trauma surgeons versus vascular surgeons. Am Surg. 2022;88(7):1420-1426. doi:10.1177/00031348221080427

20.

Harutyunyan

Hnath

Jacobson

, et al. Trauma bypass performed by vascular surgeons demonstrate excellent long-term outcomes and limb preservation. J Vasc Surg. 2023;78(3):779-787. doi:10.1016/j.jvs.2023.05.046

21.

Argandykov

Proaño-Zamudio

Dorken-Gallastegi

, et al. Timing and choice of systemic anticoagulation in the setting of extremity arterial injury repair. Eur J Trauma Emerg Surg. 2023;49(1):473-485. doi:10.1007/s00068-022-02092-w

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