Antiplatelet And/or Anticoagulation Therapy Do Not Affect Post-operative Course After Autologous Vein Repair Of Traumatic Arterial Injury
David Patrick Stonko, MD, MS1, Richard D. Betzold, MD2, Jonathan J. Morrison2, Kristofer M. Charlton-Ouw3, Thomas J. Scalea2, David V. Feliciano, MD2, Joseph J. DuBose, MD2.
1Johns Hopkins, Baltimore, MD, USA, 2University of Maryland, Shock Trauma Center, Baltimore, MD, USA, 3HCA Houston Healthcase, Houston, TX, USA.
OBJECTIVE: Practice patterns regarding the use of antiplatelet (AP) and anticoagulation (AC) therapy after autologous vein repair of traumatic arterial injury vary. We hypothesize that there is no difference in early post-operative outcomes for AP only, AC only, both AC and AP, or neither. We evaluate this question with the largest multicenter prospective database on vascular injury patients available.
METHODS: The American Association for the Surgery of Trauma (AAST) PROspective Observational Vascular Injury Treatment (PROOVIT) registry data from November 2013 to January 2019 was queried to identify traumatic arterial injuries requiring repair with a vein graft. This was a four-arm, two-model study (1. no therapy vs. AC only vs. AC + AP; 2. no therapy vs. AP only vs. AC + AP) with need for early reoperation being the primary outcome. Two ordinal logistic regression models were utilized to compare incremental medical therapy outcomes across these four groups following arterial repair.
RESULTS: 373 patients (52 no therapy, 88 antiplatelet only, 77 anticoagulation only, 156 both) from 19 institutions with autologous vein repair of arterial injury and recorded ISS were identified. Selected demographics, pre-intervention data, and results are displayed, see Table. Patients that got no therapy were younger and had a higher transfusion requirement than those who got any therapy. After controlling for age, sex, injury severity score, platelet count and first-24-hour transfusion requirement, there was no difference in need for operative re-intervention or any secondary outcome between these groups across these two models. CONCLUSIONS: While AC and AP alone or in combination do not increase post-intervention bleeding complications after arterial repair with autologous vein grafts, they also do not decrease post-repair thrombosis. A prospective randomized study is needed to determine the value of these postoperative adjuncts.
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