What is the Appropriate Time for Initiation of Thromboprophylaxis Therapy in Visceral Injury Secondary to Blunt Abdominal Trauma: A Systematic Review

The most common injury patterns in patients with blunt trauma. Nonoperative management (NOM) is the current standard of care for managing hemodynamically stable patients with blunt visceral injuries. Management of such patients is challenging due to the fear of failure of NOM and reluctance to start Venous Thromboembolism (VTE) prophylaxis early in the course of management. Objective: To determine the ideal timing of thromboprophylaxis initiation and its effects on NOM of patients with blunt visceral trauma. Materials and Methods: We searched Pubmed, CINAHL and Cochrane databases from January 2001- July 2017. • Inclusion Criteria: Studies conducted on adult patients (age > 18 years) with blunt abdominal visceral injury (hepatic, splenic and/orrenal) managed nonoperatively who received thromboprophylaxis with timing of initiation mentioned. • Exclusion Criteria: Studies reported in languages other than English and Unpublished literature. Data was collected by two independent reviewers. In case of discrepancy, a third reviewer was involved. Results: From the available literature thromboprophylaxis has not shown to increase failure of NOM when given within 48 hours. However it was also observed that delay in initiation of thromboembolic prophylaxis can potentially lead to increased thromboembolic complications. Conclusion: We recommend that venous thromboprophylaxis should be started within 48 hours post admission in trauma patients with blunt visceral injuries.