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.

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: Delayed initiation of thromboprophylaxis was not independently associated with a higher incidence of DVT after adjustment for age and activation of the massive transfusion protocol.