An article published in Injury-International Journal of the Care of the Injured [48 (2017) 1911-1916], by the AAST PROOVIT Study Group adds evidence to the body of knowledge surrounding systemic anticoagulation in trauma settings. This study was funded by the DoD via a contract to the National Trauma Institute, which is the coordinating center.
In their paper, “Systemic anticoagulation in the setting of vascular extremity trauma,” the group studied whether intraoperative systemic anticoagulation (ISA) following traumatic vascular injury decreased the risk of repair thrombosis or limb amputation (RTLA). While ISA is routinely performed for elective arterial reconstruction of acute limb ischemia, its success in the trauma setting has not been explored extensively, and the evidence is mixed. Surgeons are often reluctant to employ the procedure due to concerns about potential local or systemic bleeding.
Using data from the AAST PROspective Vascular Injury Treatment (PROOVIT) registry, the researchers found that ISA was not associated with any difference in rate of repair thrombosis or limb loss, but was associated with prolonged hospital stay and an increase in blood product use. “Our data suggest there is no significant difference in outcome to support use of ISA for repair of traumatic arterial injuries,” the researchers conclude.
“The PROOVIT registry represents the only comprehensive resource for the examination of critical issues related to vascular injury care,” said Dr. Joseph DuBose, a trauma surgeon at UC Davis and one of the study investigators. “While other data sources for examining these injuries exist, all are limited by the granularity of data available for analysis. The PROOVIT registry was specifically designed to provide this much-needed data.”
All told, the study considered composite risk of RTLA, need for reintervention following the initial operation, total units of packed red blood cells required in the first 24 hours, length of ICU stay and total hospital stay. Data from the PROOVIT registry came from 14 Level 1 trauma centers.
“Additional studies utilizing PROOVIT registry data are currently in development. This resource continues to grow in value to the trauma community through robust ongoing patient enrollment and the expanded collection of much needed long-term follow-up data,” said Dr. DuBose.