Study Links LMWH to Lower Risk of VTE in Patients With Severe Blunt Trauma

By Cailin Conner - October 2, 2023

Patients with severe blunt trauma who received low-molecular-weight heparin (LMWH) were less likely to experience venous thromboembolism (VTE) than those who received factor Xa inhibitors, according to a recent study in the International Journal of Surgery.

“Pharmacological VTE prophylactics are widely used, and LMWH is recommended. Factor Xa inhibitors are increasingly being used for VTE prophylaxis in both medical and surgical patients,” the investigators wrote. “Evidence comparing LMWH and factor Xa inhibitors as VTE prophylactics for severe blunt trauma is lacking.”

The study examined patients with severe blunt trauma who received LMWH or a factor Xa inhibitor for VTE prophylaxis between 2017 and 2019. Various outcome measures were assessed, including mortality rates, the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE), postprophylactic hemorrhage control procedures, and length of hospital stay.

After applying 2:1 propensity score matching, 1128 patients were included in the analysis. A total of 752 patients received LMWH, while 376 received a factor Xa inhibitor.

Patients in the LMWH group experienced fewer VTE events compared with those in the factor Xa inhibitor group. Specifically, the incidence of DVT was 3.7% in the LMWH group versus 7.2% in the factor Xa inhibitor group (P=.013), and the incidence of PE was 0.4% in the LMWH group versus 3.2% in the factor Xa inhibitor group (P<.001).

The risk of VTE was found to be significantly higher in the factor Xa inhibitor group, with an odds ratio of 1.97 (95% CI, 1.12-3.44; P=.018) for DVT and 9.65 (95% CI, 2.91-44.12; P=.001) for PE.

Although the mortality rate appeared to be higher in the LMWH group (4.0% vs 1.9%), this difference did not reach statistical significance (P=.075). Additionally, the risk of undergoing hemorrhage control surgery after VTE prophylaxis was not significantly different between the 2 groups (0.3% in the LMWH group vs 0.0% in the factor Xa inhibitor group; P=.333).

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