Recommended reading: top papers in the surgical literature

The authors concluded that SSAE, with reembolization if necessary, is an effective rescue treatment modality for hemodynamically unstable patients with active GIH. Of the patients, 20% will fail SSAE and require additional intervention. Ischemic complications were extremely rare.

"Platelets are dominant contributors to hypercoagulability after injury" (J. Trauma Acute Care Surg. 2013;74:756-65).

The authors randomized 50 surgical intensive care unit trauma patients to receive 5,000 IU of low-molecular-weight heparin (LMWH) daily (controls) or to thrombelastography (TEG)–guided prophylaxis, up to 5,000 IU twice daily with the addition of aspirin. Patients were followed up for 5 days. The control (n = 25) and TEG-guided prophylaxis (n = 25) groups were similar in age, body mass index, Injury Severity Score, and male sex. Fibrinogen levels and platelet counts did not differ, and increased LMWH did not affect clot strength between the control and study groups. The correlation of clot strength (G value) with fibrinogen was stronger on days 1 and 2 but was superseded by platelet count on days 3, 4, and 5. The authors concluded that increased LMWH seemed to increase platelet contribution to clot strength early in the study but failed to affect the overall rise clot strength. Over time, platelet count had the strongest correlation with clot strength, and in vitro studies demonstrated that increased platelet counts increase fibrin production and thrombus generation. These data suggest an important role for antiplatelet therapy in VTE prophylaxis following trauma, particularly after 48 hours, they stated.

Dr. Grace S. Rozycki is an ACS Fellow, Willis D. Gatch Professor of Surgery, executive vice chair of the department of surgery, and director of the Indiana Injury Institute, Indiana University, Indianapolis.