Low molecular weight heparin combined with aspirin to prevent perioperative venous thromboembolism in patients with splenic rupture and lower extremity fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Yilun ¹ , XU Yan ² , ZHANG Xiao ³ , SONG Jinhui ¹ , WANG Kunzheng ¹ ,  YANG Pei ¹

1. Department of Orthopedic and Joint Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P. R. China;
2. Department of Hematology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P. R. China;
3. Department of Surgery and Anesthesiology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P. R. China;

Corresponding author：

YANG Pei, Email: yangpei@vip.163.com

Keywords：

Venous thromboembolism; splenectomy; lower extremity fracture; prophylactic anticoagulation

DOI：

10.7507/1002-1892.202207096

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Objective To investigate the effectiveness and safety of low molecular weight heparin combined with aspirin for perioperative prophylactic anticoagulation in patients with lower extremity fracture after splenectomy. Methods The clinical data of 50 patients with splenic rupture combined with lower extremity fracture between January 2009 and June 2022 were retrospectively analyzed. All patients were given enoxaparin sodium at 48 hours after splenectomy, and stopped at 24 hours before fracture surgery. After fracture surgery, the patients were divided into aspirin group (group A, 15 cases), low molecular weight heparin group (group B, 16 cases), and low molecular weight heparin combined with aspirin group (group C, 19 cases) according to different anticoagulation regimens. The treatment course was 28 days. There was no significant difference in gender, age, body mass index, cause of injury, fracture site, time from injury to operation, complications, and other general data between groups (P>0.05). The occurrence of venous thromboembolism (VTE) was observed; hemoglobin (Hb), platelet (PLT), D-D dimer, and fibrinogen degradation product (FDP) were recorded before operation and at 1, 3, and 7 days after operation, and the effect of anticoagulation regimen on coagulation function was observed. The incidences of wound complications and bleeding related complications were recorded, and the total perioperative blood loss, hidden blood loss, and overt blood loss were calculated. Results The incidences of VTE in groups A, B, and C were 13.33% (2/15), 12.50% (2/16), and 5.26% (1/19), respectively, and there was no significant difference between groups (χ²=0.770, P=0.680). There was no portal vein thrombosis and no VTE-related death in the 3 groups. There was no significant difference in the levels of Hb, PLT, D-D dimer, and FDP between groups before and after operation (P>0.05); and there was no significant difference in total perioperative blood loss, hidden blood loss, and overt blood loss between groups (P>0.05). No local skin necrosis was found in all patients. In group A, 1 case occurred redness and swelling of incision; in group B, 1 case had incision discharge, redness, and swelling, and 1 case had fat liquefaction; in group C, 1 case had repeated incision exudation accompanied by local tissue redness and swelling, and 1 case had local hematoma. The incidences of adverse incision in groups A, B, and C were 6.66% (1/15), 12.50% (2/16), and 11.76% (2/19), respectively, with no significant difference (χ²=0.302, P=0.860). There were 4 cases of bleeding related complications, including 1 case of incision ecchymosis in groups A and B respectively, with the incidence of 6.66% and 6.25%, respectively; there was 1 case of incision hematoma and 1 case of bleeding in group C, with the incidence of 11.76%; showing no significant difference in the incidence of bleeding related complications between groups (χ²=0.268, P=0.875). Conclusion Perioperative combined use of low molecular weight heparin and aspirin for prevention of anticoagulation in patients with splenic rupture and lower extremity fracture can effectively prevent the occurrence of VTE without increasing the incidence of complications, which is an effective and safe treatment method. However, whether the incidence of VTE can be reduced needs to be further studied by expanding the sample size.

Citation： TANG Yilun, XU Yan, ZHANG Xiao, SONG Jinhui, WANG Kunzheng, YANG Pei. Low molecular weight heparin combined with aspirin to prevent perioperative venous thromboembolism in patients with splenic rupture and lower extremity fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(11): 1381-1387. doi: 10.7507/1002-1892.202207096 Copy

1.	李科研, 许家祥. 四肢骨折合并脾破裂行脾切除术后骨折内固定手术时机探讨. 中国实用医药, 2016, 11(18): 83-84.
2.	黎介寿, 吴孟超, 黄志强. 普通外科手术学. 2版. 北京:人民军医出版社, 2005: 975.
3.	高志成. 脾切除术后血小板骤增35例分析. 西南军医, 2008, 10(2): 29-30.
4.	李铁汉, 唐波, 田大广, 等. 脾切除术后门静脉系统血栓形成的临床分析. 腹部外科, 2010, 23(6): 341-343.
5.	Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med, 2010, 16(5): 448-452.
6.	Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest, 2012, 141(2 Suppl): e278S-e325S.
7.	Tan TL, Foltz C, Huang R, et al. Potent anticoagulation does not reduce venous thromboembolism in haigh-risk patients. J Bone Joint Surg (Am), 2019, 101(7): 589-599.
8.	Nadi S, Vreugdenburg TD, Atukorale Y, et al. Safety and effectiveness of aspirin and enoxaparin for venous thromboembolism prophylaxis after total hip and knee arthroplasty: a systematic review. ANZ J Surg, 2019, 89(10): 1204-1210.
9.	潘维亮, 张淑华, 徐朝阳, 等. 阿司匹林和低分子肝素对下肢骨折患者围术期血凝状态的不同影响. 济宁医学院学报, 2008, 31(1): 51-52.
10.	李晓东, 安可英, 孙国锋, 等. 低分子肝素预防老年髋关节周围骨折围术期下肢深静脉血栓的研究. 重庆医学, 2013, 42(25): 2964-2965, 2968.
11.	李兴杰, 王鹏, 杨明. 外伤性多发性肋骨骨折合并脾破裂的急诊诊断及临床治疗. 世界复合医学, 2022, 8(2): 120-123, 127.
12.	中华医学会外科学分会脾功能与脾脏外科学组. 脾脏损伤治疗方式的专家共识(2014版). 临床肝胆病杂志, 2015, 31(7): 1002-1003.
13.	Schroer WC, Calvert GT, Diesfeld PJ, et al. Effects of increased surgical volume on total knee arthroplasty complications. J Arthroplasty, 2008, 23(6 Suppl 1): 61-67.
14.	Galat DD, McGovern SC, Larson DR, et al. Surgical treatment of early wound complications following primary total knee arthroplasty. J Bone Joint Surg (Am), 2009, 91(1): 48-54.
15.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
16.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
17.	李晓强, 王深明. 深静脉血栓形成的诊断和治疗指南 (第2版). 中国医学前沿杂志 (电子版), 2013, 5(3): 53-57.
18.	颜军江, 张淑芳, 曹振刚. 围术期深静脉血栓形成的流行病学调查和相关危险因素探讨. 农垦医学, 2017, 39(4): 306-309.
19.	中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016, 36(2): 65-71.
20.	Lu JP, Knudson MM, Bir N, et al. Fondaparinux for prevention of venous thromboembolism in high-risk trauma patients: a pilot study. J Am Coll Surg, 2009, 209(5): 589-594.
21.	Lee DH, Barmparas G, Fierro N, et al. Splenectomy is associated with a higher risk for venous thromboembolism: A prospective cohort study. Int J Surg, 2015, 24(Pt A): 27-32.
22.	刘钢, 潘廷. 脾切除术后凝血机制的变化对骨折手术治疗的影响. 贵州医药, 2012, 36(2): 119-120.
23.	Cervera R, Asherson RA, Acevedo ML, et al. Antiphospholipid syndrome associated with infections: clinical and microbiological characteristics of 100 patients. Ann Rheum Dis, 2004, 63(10): 1312-1317.
24.	但刚, 吴艾霖, 刘媛, 等. 骨折患者内固定术后血小板相关参数检测的临床意义. 西南国防医药, 2011, 21(9): 950-952.
25.	陈治学, 殷力, 张翼, 等. TKA术后应用阿司匹林、低分子肝素钙和利伐沙班预防VTE疗效分析. 医药论坛杂志, 2019, 40(3): 31-33.
26.	王英芬, 谢霖, 刘启宏. 低分子肝素钙联合阿司匹林治疗产后下肢深静脉软血栓形成的临床研究. 现代实用医学, 2016, 28(5): 605-607.
27.	Cines DB, Rauova L, Arepally G, et al. Heparin-induced thrombocytopenia: an autoimmune disorder regulated through dynamic autoantigen assembly/disassembly. J Clin Apher, 2007, 22(1): 31-36.
28.	Assadian A, Senekowitsch C, Hagmüller GW, et al. Effects of enoxaparin and unfractionated heparin on platelet activity and reactivity during carotid endarterectomy. Vascular, 2008, 16(3): 161-166.
29.	裴玮娜, 谢瑞芹, 崔炜, 等. 不同途径应用低分子肝素对血小板活性的影响及阿司匹林的干预作用. 中国循环杂志, 2010, 25(1): 51-54.
30.	杨昕, 文立成, 曹永平, 等. 人工膝关节置换术后血栓性事件和血小板变化关系的研究. 中国矫形外科杂志, 2016, 24(3): 226-229.
31.	Woon CYL, Shah RR, Pardi BM, et al. Aspirin alone is not enough to prevent deep venous thrombosis after total joint arthroplasty. Orthopedics, 2019, 42(1): 48-55.
32.	杨健胜, 关万宁, 邓自立, 等. 阿司匹林预防髋关节置换术后深静脉血栓形成. 中华关节外科杂志 (电子版), 2019, 13(5): 526-529.
33.	叶志强, 张海峰, 王晶, 等. 低分子肝素钙与阿司匹林预防老年股骨粗隆间骨折术后深静脉血栓形成的效果观察. 贵州医药, 2018, 42(6): 682-684.
34.	夏智昌. 低分子肝素联合阿司匹林预防骨科术后深静脉血栓形成的临床观察. 内蒙古中医药, 2009, 28(15): 28-29.
35.	王守宝, 杨峰, 郝成俊. 低分子肝素联合阿司匹林预防老年髋部骨折术后下肢深静脉血栓形成效果观察. 临床合理用药, 2017, 10(1A): 88-89.

1. 李科研, 许家祥. 四肢骨折合并脾破裂行脾切除术后骨折内固定手术时机探讨. 中国实用医药, 2016, 11(18): 83-84.
2. 黎介寿, 吴孟超, 黄志强. 普通外科手术学. 2版. 北京:人民军医出版社, 2005: 975.
3. 高志成. 脾切除术后血小板骤增35例分析. 西南军医, 2008, 10(2): 29-30.
4. 李铁汉, 唐波, 田大广, 等. 脾切除术后门静脉系统血栓形成的临床分析. 腹部外科, 2010, 23(6): 341-343.
5. Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med, 2010, 16(5): 448-452.
6. Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest, 2012, 141(2 Suppl): e278S-e325S.
7. Tan TL, Foltz C, Huang R, et al. Potent anticoagulation does not reduce venous thromboembolism in haigh-risk patients. J Bone Joint Surg (Am), 2019, 101(7): 589-599.
8. Nadi S, Vreugdenburg TD, Atukorale Y, et al. Safety and effectiveness of aspirin and enoxaparin for venous thromboembolism prophylaxis after total hip and knee arthroplasty: a systematic review. ANZ J Surg, 2019, 89(10): 1204-1210.
9. 潘维亮, 张淑华, 徐朝阳, 等. 阿司匹林和低分子肝素对下肢骨折患者围术期血凝状态的不同影响. 济宁医学院学报, 2008, 31(1): 51-52.
10. 李晓东, 安可英, 孙国锋, 等. 低分子肝素预防老年髋关节周围骨折围术期下肢深静脉血栓的研究. 重庆医学, 2013, 42(25): 2964-2965, 2968.
11. 李兴杰, 王鹏, 杨明. 外伤性多发性肋骨骨折合并脾破裂的急诊诊断及临床治疗. 世界复合医学, 2022, 8(2): 120-123, 127.
12. 中华医学会外科学分会脾功能与脾脏外科学组. 脾脏损伤治疗方式的专家共识(2014版). 临床肝胆病杂志, 2015, 31(7): 1002-1003.
13. Schroer WC, Calvert GT, Diesfeld PJ, et al. Effects of increased surgical volume on total knee arthroplasty complications. J Arthroplasty, 2008, 23(6 Suppl 1): 61-67.
14. Galat DD, McGovern SC, Larson DR, et al. Surgical treatment of early wound complications following primary total knee arthroplasty. J Bone Joint Surg (Am), 2009, 91(1): 48-54.
15. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
16. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
17. 李晓强, 王深明. 深静脉血栓形成的诊断和治疗指南 (第2版). 中国医学前沿杂志 (电子版), 2013, 5(3): 53-57.
18. 颜军江, 张淑芳, 曹振刚. 围术期深静脉血栓形成的流行病学调查和相关危险因素探讨. 农垦医学, 2017, 39(4): 306-309.
19. 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016, 36(2): 65-71.
20. Lu JP, Knudson MM, Bir N, et al. Fondaparinux for prevention of venous thromboembolism in high-risk trauma patients: a pilot study. J Am Coll Surg, 2009, 209(5): 589-594.
21. Lee DH, Barmparas G, Fierro N, et al. Splenectomy is associated with a higher risk for venous thromboembolism: A prospective cohort study. Int J Surg, 2015, 24(Pt A): 27-32.
22. 刘钢, 潘廷. 脾切除术后凝血机制的变化对骨折手术治疗的影响. 贵州医药, 2012, 36(2): 119-120.
23. Cervera R, Asherson RA, Acevedo ML, et al. Antiphospholipid syndrome associated with infections: clinical and microbiological characteristics of 100 patients. Ann Rheum Dis, 2004, 63(10): 1312-1317.
24. 但刚, 吴艾霖, 刘媛, 等. 骨折患者内固定术后血小板相关参数检测的临床意义. 西南国防医药, 2011, 21(9): 950-952.
25. 陈治学, 殷力, 张翼, 等. TKA术后应用阿司匹林、低分子肝素钙和利伐沙班预防VTE疗效分析. 医药论坛杂志, 2019, 40(3): 31-33.
26. 王英芬, 谢霖, 刘启宏. 低分子肝素钙联合阿司匹林治疗产后下肢深静脉软血栓形成的临床研究. 现代实用医学, 2016, 28(5): 605-607.
27. Cines DB, Rauova L, Arepally G, et al. Heparin-induced thrombocytopenia: an autoimmune disorder regulated through dynamic autoantigen assembly/disassembly. J Clin Apher, 2007, 22(1): 31-36.
28. Assadian A, Senekowitsch C, Hagmüller GW, et al. Effects of enoxaparin and unfractionated heparin on platelet activity and reactivity during carotid endarterectomy. Vascular, 2008, 16(3): 161-166.
29. 裴玮娜, 谢瑞芹, 崔炜, 等. 不同途径应用低分子肝素对血小板活性的影响及阿司匹林的干预作用. 中国循环杂志, 2010, 25(1): 51-54.
30. 杨昕, 文立成, 曹永平, 等. 人工膝关节置换术后血栓性事件和血小板变化关系的研究. 中国矫形外科杂志, 2016, 24(3): 226-229.
31. Woon CYL, Shah RR, Pardi BM, et al. Aspirin alone is not enough to prevent deep venous thrombosis after total joint arthroplasty. Orthopedics, 2019, 42(1): 48-55.
32. 杨健胜, 关万宁, 邓自立, 等. 阿司匹林预防髋关节置换术后深静脉血栓形成. 中华关节外科杂志 (电子版), 2019, 13(5): 526-529.
33. 叶志强, 张海峰, 王晶, 等. 低分子肝素钙与阿司匹林预防老年股骨粗隆间骨折术后深静脉血栓形成的效果观察. 贵州医药, 2018, 42(6): 682-684.
34. 夏智昌. 低分子肝素联合阿司匹林预防骨科术后深静脉血栓形成的临床观察. 内蒙古中医药, 2009, 28(15): 28-29.
35. 王守宝, 杨峰, 郝成俊. 低分子肝素联合阿司匹林预防老年髋部骨折术后下肢深静脉血栓形成效果观察. 临床合理用药, 2017, 10(1A): 88-89.

Chinese Journal of Reparative and Reconstructive Surgery

Low molecular weight heparin combined with aspirin to prevent perioperative venous thromboembolism in patients with splenic rupture and lower extremity fracture

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