Abstract

OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) is an effective treatment for blunt thoracic aortic injury (BTAI), but the risks and benefits of administering intraoperative heparin in trauma patients are not well-defined, especially with regard to bleeding complications.METHODS: The Vascular Quality Initiative (VQI) registry was queried from 2013 to 2019 to identify patients who underwent TEVAR for BTAI with or without administration of intraoperative heparin. Univariate analyses were performed with Student's t-test, Fisher exact, and chi-squared tests where appropriate. Multivariable logistic regression was then performed to assess the association of heparin with inpatient mortality.RESULTS: 655 patients were included, of whom the majority presented with grade III (53.3%) or IV (20%) BTAI. Patients receiving heparin were less likely to have an injury severity score (ISS) = 15 (70.2% vs. 90.5%, p<0.0001), or major head or neck injury (39.6% vs. 62.9%, p<0.0001). Patients receiving heparin had lower incidence of inpatient death (5.1% vs. 12.9%, p<0.01). Across all injury grades, heparin use was not associated with intraoperative transfusion, postoperative transfusion, or hematoma. In patients with grade III BTAI, non-use of heparin was associated with an increased risk of lower extremity embolization events (7.4% vs 1.8%, P < 0.05). On multivariable logistic regression for inpatient mortality, intraoperative heparin use (OR = 0.31, 95% Confidence Interval [CI] 0.11 - 0.86, P < 0.05) and female gender (OR = 0.11, 95% CI 0.11 - 0.86, P < 0.05) were associated with better survival, even when controlling for head and neck trauma and injury grade. In contrast, increased age (OR = 1.06, 95% CI 1.03 - 1.1, P <0.001), postoperative transfusion (OR = 1.06, 95% CI 1.02 - 1.11, P < 0.01), Higher ISS (OR = 1.04, 95% CI 1.01 - 1.07, P < 0.05), postoperative dysrhythmia (OR = 4.48, 95% CI 1.10 - 18.18, P < 0.05), and postoperative stroke or transient ischemic attack (OR = 5.54, 95% CI 1.11 - 27.67, P < 0.05) were associated with increased odds of inpatient mortality.CONCLUSIONS: Intraoperative heparin use is associated with reduced inpatient mortality in patients undergoing during TEVAR for BTAI, including those with major head or neck trauma and high injury severity scores. Heparin did not increase risk of hemorrhagic complications across all injury grades, and in patients with grade III BTAI heparin use was associated with a reduced risk of lower extremity embolic events. Heparin appears to be safe during TEVAR for BTAI, and should be administered when no specific contraindication exists.

View details for DOI 10.1016/j.jvs.2020.12.068

View details for PubMedID 33348003