Early versus late venous thromboembolism: A secondary analysis of data from the PROPPR trial

PROPPR Study Group

    Research output: Contribution to journalArticle

    Abstract

    Background: Factors predicting timing of post-traumatic venous thromboembolism (VTE) remain incompletely understood. Because the balance between hemorrhage and thrombosis is dynamic during a patient's hospital course, early and late VTE may be physiologically discrete processes. This secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial aims to explore whether certain risk factors are associated with early versus late VTE. Methods: The PROPPR trial investigated post-traumatic resuscitation with platelets, plasma, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio. Multinomial regression based on a threshold determined by cubic spline analysis tested the association of clinical variables with early or late VTE, a composite of deep vein thrombosis and pulmonary embolus, adjusting for predetermined confounders. Results: Of the 87 patients (13%) with VTE, pulmonary embolus was predominant in the first 72 hours. A statistically determined threshold at 12 days corresponded to change in odds of early versus late events. Variables associated with early VTE included plasma transfusion (risk ratio [RR] 1.14; 95% confidence interval, 1.00, 1.30; P = .05), sepsis (RR 0.05; 95% confidence interval, 1.40, 6.64; P = .01), pelvic or femur fracture (RR 2.62; 95% confidence interval, 1.00, 6.90; P = .05). Late VTE was associated with dialysis (RR 7.37; 95% confidence interval, 1.59, 34.14; P = .01), older age (RR 1.02; 95% confidence interval 1.00, 1.04; P = .05), and delayed resuscitation approaching ratios of 1:1:1 among patients randomized to 1:1:2 therapy (RR 2.06; 95% confidence interval, 0.28, 3.83; P = .02). Cyroprecipitate increased risk of early (RR 1.04, 95% confidence interval, 1.00,1.08; P < .03) and late VTE (1.05; 95% confidence interval, 1.01, 1.09; P = .01). Prolonged lagtime (coeffcient 0.06, 95% confidence interval, 0.02, 0.10; P < .01) and time-to-peak thrombin generation (coeffcient 0.04, 95% confidence interval, 0.02, 0.07; P < .01) were associated with increased risk of early VTE. Conclusion: Early and late VTE may differ in their risk factors. Defining temporal trends in VTE may allow for a more individualized approach to thromboprophylaxis.

    Original languageEnglish (US)
    JournalSurgery (United States)
    DOIs
    StatePublished - Jan 1 2019

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    Venous Thromboembolism
    Blood Platelets
    Confidence Intervals
    Odds Ratio
    Embolism
    Resuscitation
    Lung
    Thrombin
    Venous Thrombosis
    Femur
    Dialysis
    Sepsis
    Thrombosis
    Erythrocytes
    Hemorrhage

    ASJC Scopus subject areas

    • Surgery

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    Early versus late venous thromboembolism : A secondary analysis of data from the PROPPR trial. / PROPPR Study Group.

    In: Surgery (United States), 01.01.2019.

    Research output: Contribution to journalArticle

    @article{37290faf0daa4ab58943fd4ac3147719,
    title = "Early versus late venous thromboembolism: A secondary analysis of data from the PROPPR trial",
    abstract = "Background: Factors predicting timing of post-traumatic venous thromboembolism (VTE) remain incompletely understood. Because the balance between hemorrhage and thrombosis is dynamic during a patient's hospital course, early and late VTE may be physiologically discrete processes. This secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial aims to explore whether certain risk factors are associated with early versus late VTE. Methods: The PROPPR trial investigated post-traumatic resuscitation with platelets, plasma, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio. Multinomial regression based on a threshold determined by cubic spline analysis tested the association of clinical variables with early or late VTE, a composite of deep vein thrombosis and pulmonary embolus, adjusting for predetermined confounders. Results: Of the 87 patients (13{\%}) with VTE, pulmonary embolus was predominant in the first 72 hours. A statistically determined threshold at 12 days corresponded to change in odds of early versus late events. Variables associated with early VTE included plasma transfusion (risk ratio [RR] 1.14; 95{\%} confidence interval, 1.00, 1.30; P = .05), sepsis (RR 0.05; 95{\%} confidence interval, 1.40, 6.64; P = .01), pelvic or femur fracture (RR 2.62; 95{\%} confidence interval, 1.00, 6.90; P = .05). Late VTE was associated with dialysis (RR 7.37; 95{\%} confidence interval, 1.59, 34.14; P = .01), older age (RR 1.02; 95{\%} confidence interval 1.00, 1.04; P = .05), and delayed resuscitation approaching ratios of 1:1:1 among patients randomized to 1:1:2 therapy (RR 2.06; 95{\%} confidence interval, 0.28, 3.83; P = .02). Cyroprecipitate increased risk of early (RR 1.04, 95{\%} confidence interval, 1.00,1.08; P < .03) and late VTE (1.05; 95{\%} confidence interval, 1.01, 1.09; P = .01). Prolonged lagtime (coeffcient 0.06, 95{\%} confidence interval, 0.02, 0.10; P < .01) and time-to-peak thrombin generation (coeffcient 0.04, 95{\%} confidence interval, 0.02, 0.07; P < .01) were associated with increased risk of early VTE. Conclusion: Early and late VTE may differ in their risk factors. Defining temporal trends in VTE may allow for a more individualized approach to thromboprophylaxis.",
    author = "{PROPPR Study Group} and Myers, {Sara P.} and Brown, {Joshua B.} and Leeper, {Christine M.} and Kutcher, {Matthew E.} and Xilin Chen and Wade, {Charles E.} and Holcomb, {John B.} and Martin Schreiber and Cardenas, {Jessica C.} and Rosengart, {Matthew R.} and Neal, {Matthew D.}",
    year = "2019",
    month = "1",
    day = "1",
    doi = "10.1016/j.surg.2019.04.014",
    language = "English (US)",
    journal = "Surgery (United States)",
    issn = "0039-6060",
    publisher = "Mosby Inc.",

    }

    TY - JOUR

    T1 - Early versus late venous thromboembolism

    T2 - A secondary analysis of data from the PROPPR trial

    AU - PROPPR Study Group

    AU - Myers, Sara P.

    AU - Brown, Joshua B.

    AU - Leeper, Christine M.

    AU - Kutcher, Matthew E.

    AU - Chen, Xilin

    AU - Wade, Charles E.

    AU - Holcomb, John B.

    AU - Schreiber, Martin

    AU - Cardenas, Jessica C.

    AU - Rosengart, Matthew R.

    AU - Neal, Matthew D.

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Background: Factors predicting timing of post-traumatic venous thromboembolism (VTE) remain incompletely understood. Because the balance between hemorrhage and thrombosis is dynamic during a patient's hospital course, early and late VTE may be physiologically discrete processes. This secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial aims to explore whether certain risk factors are associated with early versus late VTE. Methods: The PROPPR trial investigated post-traumatic resuscitation with platelets, plasma, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio. Multinomial regression based on a threshold determined by cubic spline analysis tested the association of clinical variables with early or late VTE, a composite of deep vein thrombosis and pulmonary embolus, adjusting for predetermined confounders. Results: Of the 87 patients (13%) with VTE, pulmonary embolus was predominant in the first 72 hours. A statistically determined threshold at 12 days corresponded to change in odds of early versus late events. Variables associated with early VTE included plasma transfusion (risk ratio [RR] 1.14; 95% confidence interval, 1.00, 1.30; P = .05), sepsis (RR 0.05; 95% confidence interval, 1.40, 6.64; P = .01), pelvic or femur fracture (RR 2.62; 95% confidence interval, 1.00, 6.90; P = .05). Late VTE was associated with dialysis (RR 7.37; 95% confidence interval, 1.59, 34.14; P = .01), older age (RR 1.02; 95% confidence interval 1.00, 1.04; P = .05), and delayed resuscitation approaching ratios of 1:1:1 among patients randomized to 1:1:2 therapy (RR 2.06; 95% confidence interval, 0.28, 3.83; P = .02). Cyroprecipitate increased risk of early (RR 1.04, 95% confidence interval, 1.00,1.08; P < .03) and late VTE (1.05; 95% confidence interval, 1.01, 1.09; P = .01). Prolonged lagtime (coeffcient 0.06, 95% confidence interval, 0.02, 0.10; P < .01) and time-to-peak thrombin generation (coeffcient 0.04, 95% confidence interval, 0.02, 0.07; P < .01) were associated with increased risk of early VTE. Conclusion: Early and late VTE may differ in their risk factors. Defining temporal trends in VTE may allow for a more individualized approach to thromboprophylaxis.

    AB - Background: Factors predicting timing of post-traumatic venous thromboembolism (VTE) remain incompletely understood. Because the balance between hemorrhage and thrombosis is dynamic during a patient's hospital course, early and late VTE may be physiologically discrete processes. This secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial aims to explore whether certain risk factors are associated with early versus late VTE. Methods: The PROPPR trial investigated post-traumatic resuscitation with platelets, plasma, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio. Multinomial regression based on a threshold determined by cubic spline analysis tested the association of clinical variables with early or late VTE, a composite of deep vein thrombosis and pulmonary embolus, adjusting for predetermined confounders. Results: Of the 87 patients (13%) with VTE, pulmonary embolus was predominant in the first 72 hours. A statistically determined threshold at 12 days corresponded to change in odds of early versus late events. Variables associated with early VTE included plasma transfusion (risk ratio [RR] 1.14; 95% confidence interval, 1.00, 1.30; P = .05), sepsis (RR 0.05; 95% confidence interval, 1.40, 6.64; P = .01), pelvic or femur fracture (RR 2.62; 95% confidence interval, 1.00, 6.90; P = .05). Late VTE was associated with dialysis (RR 7.37; 95% confidence interval, 1.59, 34.14; P = .01), older age (RR 1.02; 95% confidence interval 1.00, 1.04; P = .05), and delayed resuscitation approaching ratios of 1:1:1 among patients randomized to 1:1:2 therapy (RR 2.06; 95% confidence interval, 0.28, 3.83; P = .02). Cyroprecipitate increased risk of early (RR 1.04, 95% confidence interval, 1.00,1.08; P < .03) and late VTE (1.05; 95% confidence interval, 1.01, 1.09; P = .01). Prolonged lagtime (coeffcient 0.06, 95% confidence interval, 0.02, 0.10; P < .01) and time-to-peak thrombin generation (coeffcient 0.04, 95% confidence interval, 0.02, 0.07; P < .01) were associated with increased risk of early VTE. Conclusion: Early and late VTE may differ in their risk factors. Defining temporal trends in VTE may allow for a more individualized approach to thromboprophylaxis.

    UR - http://www.scopus.com/inward/record.url?scp=85067515331&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85067515331&partnerID=8YFLogxK

    U2 - 10.1016/j.surg.2019.04.014

    DO - 10.1016/j.surg.2019.04.014

    M3 - Article

    AN - SCOPUS:85067515331

    JO - Surgery (United States)

    JF - Surgery (United States)

    SN - 0039-6060

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