Systemic intraoperative anticoagulation during arterial injury repair: Implications for patency and bleeding.

Background: The role of systemic intraoperative anticoagulation (SIAC) during surgical repair of major arterial injuries is controversial. Any potential improvement in arterial patency must be weighed against the risk of hemorrhage in these critically injured patients. We hypothesized that SIAC would increase arterial patency without increasing bleeding complications. Methods: We conducted a multi-institution, retrospective cohort study of trauma patients with major vascular injury from 2005-2013 in 3 level I centers. Arterial injuries of the neck, torso and proximal extremities requiring operative management were included. Our primary endpoint was maintenance of arterial patency during index hospitalization. Complications related to bleeding were assessed. The association between SIAC and arterial patency was evaluated using Chi-Square, t-test and multiple logistic regression modeling. Results: Of 323 study patients, most were male (88%) and injured by gunshot wounds (69%). Patients repaired with SIAC (n=154) were compared to those repaired without SIAC (n=169). No difference in age, gender, mechanism, admission heart rate, or concomitant injury was detected between the groups (all p>0.05). SIAC use was associated with greater arterial patency rates (93% vs. 85%, p=0.02) without increasing return to OR for bleeding (4% vs. 6%, p=0.29). After controlling for gender, admission hemodynamics, ISS, injury location and postoperative anticoagulation, multivariable regression determined SIAC patients were 2.6 times more likely (OR 2.6, 95%CI 1.1-6.2, p=0.03) to maintain patency. Patients who maintained arterial patency were then less likely to return to the OR (9% vs. 78%, p

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