Solid Organ Injury

1. Chemical VTE prophylaxis should be initiated in patients with moderate (AAST grades 1-3- liver, spleen, kidney) solid organ injury in the absence of:

a. Hemodynamic instability

b. Hemoglobin drops greater than 2 g/dL in less than 12 hours

c. Ongoing blood transfusion after the initial resuscitation has been completed. 24,29,40,41

2. Chemical VTE prophylaxis started within 12-24 hours of injury in this cohort decreased VTE rates without an increased risk of bleeding that required blood transfusion or intervention.42

3. There is insufficient evidence on outcomes related to patients with grade 4 and 5 injuries because these patients often undergo operative management. All Grade 4 and 5 splenic injuries should undergo splenectomy. (See JTS Blunt Abdominal Trauma, Splenectomy, and Post-Splenectomy Vaccination CPG). Initiating chemical VTE prophylaxis post-operatively, in the absence of coagulopathy or other increased risk of bleeding, is considered safe.