Abstract
Background
Thromboprophylaxis for deep vein thrombosis (DVT) after lower-extremity trauma could
include rivaroxaban, an oral medication that does not need laboratory monitoring.
Objective
To assess rivaroxaban’s efficacy in preventing DVTs after pelvic trauma compared to
its historical incidence.
Materials and Methods
All patients admitted with pelvic fractures in a 12-month period followed a standardized
thromboprophylaxis protocol: 1) rivaroxaban 10 mg/day within 24 h of injury or upon
hemodynamic stability; 2) pre-operative, post-operative, and 30-day extremity ultrasound;
3) ventilation-perfusion scintigraphy for clinical signs of pulmonary embolus; and
4) a 45-, 90-, and 120-day re-evaluation. Rivaroxaban administration ceased the day
of surgery and restarted 12 h post-operatively or upon hemodynamic stability, continuing
for 30 days. Excluded patients had severe neurological or hepatosplenic injuries,
heparin hypersensitivity, or hemodynamic instability.
Results
Of 113 patients assessed, 84 patients (66 males), average age 46.6 years (range 19–69
years), were included. They had isolated pelvic trauma (n = 37), associated lower
limb injuries (n = 47), average Injury Severity Score 21.4 (range 16–50), and average
Glasgow Coma Scale score 13.6 (range 9–15). Patients receiving thromboprophylaxis
soon after their fracture (n = 64) had a lower incidence of DVT than those receiving
delayed thromboprophylaxis (n = 20) (p = 0.02). One patient (1.2%) died from a pulmonary embolus; 13 had asymptomatic below-the-knee
DVTs. Rivaroxaban did not increase intra- or post-operative bleeding in surgical wounds.
Conclusions
DVT incidence after pelvic fractures is reduced by administering antithrombotics within
24 h of injury or, if the patient is hemodynamically unstable, 24 h after stabilization.
Rivaroxaban is a safe and effective method of providing this thromboprophylaxis.
Keywords
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Article info
Publication history
Published online: January 13, 2012
Accepted:
September 18,
2011
Received in revised form:
September 12,
2011
Received:
May 6,
2011
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
