422 Safety and Efficacy of Ultra-Early Chemical Venous Thromboembolism Prophylaxis Following Surgery for Spinal Trauma

INTRODUCTION: Patients hospitalized for traumatic spine injury have an elevated risk for venous thromboembolism (VTE) and thus early initiation of chemical VTE prophylaxis is critical. In the setting of surgical intervention, the risk of post-operative bleeding from early initiation must be weighed against the risk of elevated VTE development from delayed initiation. There is a lack of consensus on ideal timing of chemical VTE prophylaxis initiation in this population. METHODS: Patients who underwent surgery for spinal trauma at our institution were identified. Date of surgery, start date of VTE prophylaxis, complication rates, and other relevant data were collected. Patients who started VTE prophylaxis within 24 hours of surgery were put in the ultra-early group, and those who started after 24 hours in the standard group. Fisher’s exact test was utilized to compare rates of clotting complications and bleeding complications between groups. RESULTS: 261 patients (mean age 50.1, 67.8% male) were included. 163 patients (62%) were in the ultra-early prophylaxis group, compared to 98 (38%) in the standard group. 16 of 261 (6%) patients experienced VTE. Differences in rates of clotting complications in the ultra-early vs standard VTE prophylaxis groups were not statistically significant (early: 7.5%, late 4.1%; p=0.30). 6 of 261 (2%) experienced bleeding complications, 2 of which were GI bleeds and 4 of which were surgical site hematomas. Differences in rates of bleeding complications in the ultra-early vs standard VTE prophylaxis groups were not statistically significant (early: 2.5%, late 2.0%; p>0.99). CONCLUSIONS: There were no significant differences in rates of DVT or bleeding complications between groups. We provide evidence that ultra-early initiation of chemical DVT prophylaxis is safe and should be considered in this population.