Associação entre a tromboprofilaxia tardia e a incidência de trombose venosa profunda em pacientes com trauma pélvico: coorte retrospectiva ajustada para gravidade em um centro de trauma de nível I

Jihad Manaf El Sayed; Guilherme Marum Olmedo; Adilia Maria Pires Sciarra; Lilian Castiglioni; Paulo César Espada

doi:10.1590/1677-5449.202600401

Original Article

Associação entre a tromboprofilaxia tardia e a incidência de trombose venosa profunda em pacientes com trauma pélvico: coorte retrospectiva ajustada para gravidade em um centro de trauma de nível I

Association between delayed thromboprophylaxis and the incidence of deep vein thrombosis in patients with pelvic trauma: a retrospective cohort adjusted for severity at a level I trauma center

Jihad Manaf El Sayed; Guilherme Marum Olmedo; Adilia Maria Pires Sciarra; Lilian Castiglioni; Paulo César Espada

http://dx.doi.org/10.1590/1677-5449.202600401 J Vasc Bras, vol.25, e20260040, 2026

PDF

Downloads: 2

Resumo

Contexto: Pacientes com trauma pélvico apresentam elevado risco de trombose venosa profunda, enquanto o início precoce da tromboprofilaxia pode aumentar o risco hemorrágico em indivíduos hemodinamicamente instáveis. O momento ideal para introdução da anticoagulação permanece controverso.

Objetivos: Avaliar se o início tardio da profilaxia farmacológica está associado à ocorrência de trombose venosa profunda em pacientes com trauma pélvico após ajuste para idade e ativação do protocolo de transfusão maciça.

Métodos: Estudo observacional de coorte retrospectiva, conduzido em um centro de trauma de nível I entre janeiro de 2022 e dezembro de 2023, incluiu pacientes adultos com trauma pélvico. A exposição principal foi início da tromboprofilaxia farmacológica em até 48 horas (precoce) versus após 48 horas (tardia). O desfecho primário foi ocorrência de trombose venosa profunda durante a internação. Realizou-se regressão logística multivariada ajustada para idade e ativação do protocolo de transfusão maciça.

Resultados: Analisaram-se 62 pacientes, com idade média de 47,71±19,91 anos, e predominância do sexo masculino (66,1%). A incidência global de trombose venosa profunda foi de 32,3% (n = 20). Na análise bivariada, a incidência foi de 35,3% no grupo de início tardio e 28,6% no grupo de início precoce (p = 0,598). Na análise multivariada, o início precoce não se associou independentemente à ocorrência de trombose venosa profunda (odds ratio 0,65; intervalo de confiança de 95% 0,21-2,00; p = 0,456).

Conclusões: O início tardio da tromboprofilaxia não apresentou associação independente com maior incidência de trombose venosa profunda após ajuste para idade e ativação do protocolo de transfusão maciça.

Palavras-chave

pelve; trauma; trombose venosa profunda; profilaxia; anticoagulantes

Abstract

Background: Patients with pelvic trauma are at high risk for deep vein thrombosis (DVT), but early initiation of thromboprophylaxis may increase bleeding risk in hemodynamically unstable individuals. The optimal timing for initiation of anticoagulation remains controversial.

Objectives: To evaluate whether delayed initiation of pharmacologic prophylaxis is associated with a higher incidence of DVT in patients with pelvic trauma, after adjustment for age and activation of the massive transfusion protocol.

Methods: This retrospective observational cohort study was conducted at a Level I trauma center from January 2022 to December 2023. Adult patients with computed tomography–confirmed pelvic trauma who underwent Doppler ultrasonography during hospitalization were included. The primary exposure was initiation of pharmacologic prophylaxis within 48 hours (early) vs. after 48 hours (delayed). The primary outcome was occurrence of DVT during hospitalization. Multivariable logistic regression was conducted, adjusting for age and activation of the massive transfusion protocol.

Results: A total of 62 patients were analyzed, with a mean age of 47.71 ± 19.91 years and predominance of male sex (66.1%). The overall incidence of DVT was 32.3% (n=20). In the bivariate analysis, DVT incidence was 35.3% in the delayed group and 28.6% in the early group (p = 0.598). In the multivariable analysis, early initiation was not independently associated with the occurrence of DVT (OR 0.65; 95% CI 0.21–2.00; p = 0.456).

Conclusions: O início tardio da tromboprofilaxia não apresentou associação independente com maior incidência de trombose venosa profunda após ajuste para idade e ativação do protocolo de transfusão maciça.

Keywords

pelvis; wounds and injuries; venous thrombosis; disease prevention; anticoagulants

References

1 Mahmoud SS, Esser M, Jain A. Thromboembolic events in pelvic and acetabulum fractures: a systematic review of the current literature on incidence, screening, and thromboprophylaxis. Int Orthop. 2022;46(8):1707-20. https://doi.org/10.1007/s00264-022-05431-z. PMid:35543748.

2 Khan F, Tritschler T, Kahn SR, Rodger MA. Venous thromboembolism. Lancet. 2021;398(10294):64-77. https://doi.org/10.1016/S0140-6736(20)32658-1. PMid:33984268.

3 Pape HC, Moore EE, McKinley T, Sauaia A. Pathophysiology in patients with polytrauma. Injury. 2022;53(7):2400-12. https://doi.org/10.1016/j.injury.2022.04.009. PMid:35577600.

4 Rossaint R, Afshari A, Bouillon B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80. https://doi.org/10.1186/s13054-023-04327-7. PMid:36859355.

5 Freeark RJ, Boswick J, Fardin R. Posttraumatic venous thrombosis. Arch Surg. 1967;95(4):567-75. https://doi.org/10.1001/archsurg.1967.01330160037005. PMid:5006628.

6 Zhang BF, Wei X, Huang H, et al. Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients. Clin Interv Aging. 2018;13:681-9. https://doi.org/10.2147/CIA.S161191. PMid:29713152.

7 Cerbasi S, Bernasconi A, Balato G, et al. Assessment of deep vein thrombosis using routine pre- and postoperative duplex Doppler ultrasound in patients with pelvic trauma: a prospective study. Bone Joint J. 2022;104-B(2):283-9. https://doi.org/10.1302/0301-620X.104B2.BJJ-2021-0764.R2. PMid:35094570.

8 Hadizie D, Deyoi YB, Faisham WI, Yahaya S, Ghani SA, Ahmad-Mohd-Zain MR. Study of deep vein thrombosis screening by using ultrasound Doppler in patients with pelvic and acetabulum fractures requiring operative intervention. Malays Orthop J. 2022;16(1):51-7. https://doi.org/10.5704/MOJ.2203.008. PMid:35519516.

9 Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12(1):5. https://doi.org/10.1186/s13017-017-0117-6. PMid:28115984.

10 Baker JE, Werner NL, Burlew CC. Management of pelvic trauma. Surg Clin North Am. 2024;104(2):367-84. https://doi.org/10.1016/j.suc.2023.10.001. PMid:38453308.

11 Schellenberg M, Benjamin E, Inaba K, et al. When is it safe to start pharmacologic venous thromboembolism prophylaxis after pelvic fractures? A prospective study from a Level I trauma center. J Surg Res. 2021;258:272-7. https://doi.org/10.1016/j.jss.2020.08.077. PMid:33039635.

12 Shetty A, Aggarwal S, Patel S, Sharma S, Jindal K, Prakash M. Early versus delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma: a prospective study. Injury. 2022;53(2):529-33. https://doi.org/10.1016/j.injury.2021.09.047. PMid:34635338.

13 Meneses E, Boneva D, McKenney M, Elkbuli A. Massive transfusion protocol in adult trauma population. Am J Emerg Med. 2020;38(12):2661-6. https://doi.org/10.1016/j.ajem.2020.07.041. PMid:33071074.

14 Jebbia M, Nguyen J, Marty M, et al. Predictors of mortality in trauma patients receiving massive transfusion protocol. Am Surg. 2023;89(10):4089-94. https://doi.org/10.1177/00031348231175503. PMid:37194204.

15 Rondanelli AM, Gómez-Sierra MA, Ossa AA, Hernández RD, Torres M. Damage control in orthopaedical and traumatology. Colomb Med. 2021;52(2):e4184802. https://doi.org/10.25100/cm.v52i2.4802. PMid:35027781.

16 Tullington JE, Blecker N. Pelvic trauma [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [citado 2026 mar 15]. https://www.ncbi.nlm.nih.gov/books/NBK556070/

17 Hamada SR, Espina C, Guedj T, et al. High level of venous thromboembolism in critically ill trauma patients despite early and well-driven thromboprophylaxis protocol. Ann Intensive Care. 2017;7(1):97. https://doi.org/10.1186/s13613-017-0315-0. PMid:28900890.

18 Tran A, Fernando SM, Carrier M, et al. Efficacy and safety of low molecular weight heparin versus unfractionated heparin for prevention of venous thromboembolism in trauma patients: a systematic review and meta-analysis. Ann Surg. 2022;275(1):19-28. https://doi.org/10.1097/SLA.0000000000005157. PMid:34387202.

19 Sobreira ML, Yoshida WB, Lastória S, et al. Diretrizes sobre trombose venosa profunda da Sociedade Brasileira de Angiologia e Cirurgia Vascular. J Vasc Bras. 2024;23:e202301071. https://doi.org/10.1590/1677-5449.202301071.

20 Zhao W, Zhao J, Liu T, Liu Z, Liu L, Zhang Y. Incidence and risk factors of preoperative deep venous thrombosis following pelvic and acetabular fractures: a retrospective case-control study. J Orthop Surg Res. 2022;17(1):77. https://doi.org/10.1186/s13018-022-02972-2. PMid:35123537.

Submitted date:
03/29/2026

Accepted date:
06/15/2026

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">

Associação entre a tromboprofilaxia tardia e a incidência de trombose venosa profunda em pacientes com trauma pélvico: coorte retrospectiva ajustada para gravidade em um centro de trauma de nível I

Association between delayed thromboprophylaxis and the incidence of deep vein thrombosis in patients with pelvic trauma: a retrospective cohort adjusted for severity at a level I trauma center

Jihad Manaf El Sayed; Guilherme Marum Olmedo; Adilia Maria Pires Sciarra; Lilian Castiglioni; Paulo César Espada

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

J Vasc Bras