# Hemorrhage Versus Thrombosis: A Risk Assessment for Anticoagulation Management in Pelvic Ring and Acetabular Fractures—A Registry-Based Study

## TL;DR

This study assesses the risks of bleeding and blood clots in patients with pelvic and hip fractures to guide anticoagulation management.

## Contribution

The study provides a risk assessment framework for anticoagulation in pelvic and acetabular fractures based on age, injury severity, and patient characteristics.

## Key findings

- Thrombotic events were most common in patients aged 41–50, while hemorrhage was more frequent in younger and older patients.
- Pelvic ring fractures in elderly patients and high injury severity scores were linked to bleeding complications.
- Preoperative hemorrhage risk was perceived higher, but thrombosis risk was seen as more critical during surgery.

## Abstract

Background: The increasing incidence of pelvic ring and acetabular fractures represents a major challenge in the field of trauma surgery. Hemorrhage and thrombosis are among the most severe complications associated with these injuries. The common instability of those fractures, together with an anatomic proximity to blood vessels, increases the risk of perioperative bleeding. Vascular wall irritation during surgery additionally adds to a substantial risk for thrombotic events. Therefore, evaluating the risk for hemorrhage and thrombosis in pelvic ring and acetabular fractures is vital to identify an adequate anticoagulation management. Methods: The incidence of hemorrhagic and thrombotic events, as well as the association of patient characteristics with the investigated outcomes of 16,359 cases, were analyzed retrospectively using data from the German Pelvic Trauma Registry. Moreover, a risk assessment survey was conducted among traumatologists experienced in pelvic ring and acetabular surgery. The results were compared to those of the registry study. Results: A high rate of thrombotic events was found in the middle-age decade (41–50 years). In patients with an age ≤ 40 and >50 years, hemorrhage complications predominated. The logistic regression identified pelvic ring fractures in geriatric patients, acetabular fractures, and Injury Severity Score (ISS) ≥ 16 to be associated with bleeding complications. Factors associated with thrombosis included pelvic ring fractures in non-geriatric patients, acetabular fractures in geriatric and non-geriatric patients, ISS, and male gender. The survey demonstrated that preoperatively, the risk for hemorrhage was considered more significant. Perioperatively, however, thrombosis was regarded as more important. Conclusions: Separate guidelines for prophylactic anticoagulation in pelvic ring and acetabular fractures that also consider individual patient characteristics, such as age, gender, and ISS, are necessary to improve perioperative management and reduce the morbidity and mortality associated with these injuries.