Venous thromboembolism chemoprophylaxis in traumatic brain injury: is a conservative approach justified?

2021 ◽  
Vol 23 (4) ◽  
pp. 359-360
Author(s):  
Andrew Udy ◽  
◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Venous Thromboembolism ◽  
Brain Injury ◽  
Conservative Approach

Chemoprophylaxis and Venous Thromboembolism in Traumatic Brain Injury at Different Trauma Centers

2020 ◽  
Vol 86 (4) ◽  
pp. 362-368
Author(s):  
Eric O. Yeates ◽  
Areg Grigorian ◽  
Sebastian D. Schubl ◽  
Catherine M. Kuza ◽  
Victor Joe ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Venous Thromboembolism ◽  
Brain Injury ◽  
Trauma Centers ◽  
Improvement Program ◽  
Level Ii ◽  
Increased Risk ◽  
Scale Scores ◽  
Severe Tbi ◽  
Level I

Patients with severe traumatic brain injury (TBI) are at an increased risk of venous thromboembolism (VTE). Because of concerns of worsening intracranial hemorrhage, clinicians are hesitant to start VTE chemoprophylaxis in this population. We hypothesized that ACS Level I trauma centers would be more aggressive with VTE chemoprophylaxis in adults with severe TBI than Level II centers. We also predicted that Level I centers would have a lower risk of VTE. We queried the Trauma Quality Improvement Program (2010–2016) database for patients with Abbreviated Injury Scale scores of 4 and 5 of the head and compared them based on treating the hospital trauma level. Of 204,895 patients with severe TBI, 143,818 (70.2%) were treated at Level I centers and 61,077 (29.8%) at Level II centers. The Level I cohort had a higher rate of VTE chemoprophylaxis use (43.2% vs 23.3%, P < 0.001) and a shorter median time to chemoprophylaxis (61.9 vs 85.9 hours, P < 0.001). Although Level I trauma centers started VTE chemoprophylaxis more often and earlier than Level II centers, there was no difference in the risk of VTE ( P = 0.414) after controlling for covariates. Future prospective studies are warranted to evaluate the timing, safety, and efficacy of early VTE chemoprophylaxis in severe TBI patients.

Interrupted Pharmocologic Thromboprophylaxis Increases Venous Thromboembolism in Traumatic Brain Injury

2011 ◽  
Vol 70 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Kristin Salottolo ◽  
Patrick Offner ◽  
A. Stewart Levy ◽  
Charles W. Mains ◽  
Denetta S. Slone ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Venous Thromboembolism ◽  
Brain Injury

Venous thromboembolism in the setting of pediatric traumatic brain injury

2014 ◽  
Vol 13 (4) ◽  
pp. 448-455 ◽  
Author(s):  
Dominic A. Harris ◽  
Sandi Lam
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Venous Thromboembolism ◽  
Brain Injury ◽  
Orthopedic Surgery ◽  
Pediatric Population ◽  
Older Age ◽  
Nonaccidental Trauma ◽  
Venous Catheterization ◽  
Inpatient Database

Object The risk of venous thromboembolism (VTE) in children with traumatic brain injury (TBI) has not been well characterized given its rarity in the pediatric population. Investigation of risk factors for VTE in this group requires the use of a large sample size. Using nationally representative hospital discharge data for 2009, the authors of this study characterize the incidence and risk factors for VTE in children hospitalized for TBI. Methods The authors conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project Kids' Inpatient Database to examine VTE in TBI-associated hospitalizations for patients 20 years of age or younger during the year 2009. Results There were 58,529 children with TBI-related admissions, including 267 with VTE diagnoses. Venous thromboembolisms occurred in 4.6 per 1000 TBI-associated hospitalizations compared with 1.2 per 1000 pediatric hospitalizations overall. By adjusted logistic regression, patients significantly more likely to be diagnosed with VTE had the following: older age of 15–20 years (adjusted odds ratio [aOR] 3.7, 95% CI 1.8–8.0), venous catheterization (aOR 3.0, 95% CI 2.0–4.6), mechanical ventilation (aOR 1.9, 95% CI 1.2–2.9), tracheostomy (aOR 2.3, 95% CI 1.3–4.0), nonaccidental trauma (aOR 2.8, 95% CI 1.1–6.9), increased length of stay (aOR 1.02, 95% CI 1.01–1.03), orthopedic surgery (aOR 2.4, 95% CI 1.8–3.4), and cranial surgery (aOR 1.8, 95% CI 1.1–2.8). Conclusions Using the Kids' Inpatient Database, the authors found that risk factors for VTE in the setting of TBI in the pediatric population include older age, venous catheterization, nonaccidental trauma, increased length of hospital stay, orthopedic surgery, and cranial surgery.

Incidence of venous thromboembolism in patients with traumatic brain injury

2007 ◽  
Vol 193 (3) ◽  
pp. 380-384 ◽  
Author(s):  
Kent Denson ◽  
Daniel Morgan ◽  
Rob Cunningham ◽  
Anthony Nigliazzo ◽  
Daniel Brackett ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Venous Thromboembolism ◽  
Brain Injury

Late Venous Thromboembolism Prophylaxis after Craniotomy in Acute Traumatic Brain Injury

2015 ◽  
Vol 81 (2) ◽  
pp. 207-211 ◽  
Author(s):  
Mitchell J. Daley ◽  
Sadia Ali ◽  
Carlos V. R. Brown
Keyword(s):  
Traumatic Brain Injury ◽  
Venous Thromboembolism ◽  
Brain Injury ◽  
Trauma Patients ◽  
Thromboembolism Prophylaxis ◽  
Treatment Groups ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
Pharmacologic Prophylaxis ◽  
Level I

The objective of this study is to compare rates of venous thromboembolism (VTE) in patients who receive enoxaparin prophylaxis compared with no enoxaparin prophylaxis after craniotomy for traumatic brain injury (TBI). This retrospective cohort evaluated all trauma patients admitted to a Level I trauma center from January 2006 to December 2011 who received craniotomy after acute TBI. Patients were excluded if developed VTE before administration of enoxaparin or they died within the first 72 hours of hospital admission. A total of 271 patients were included (enoxaparin prophylaxis, n = 45; no enoxaparin prophylaxis, n = 225). The median time until enoxaparin initiation was 11 ± 1 days. There was no significant difference in the proportion of patients who developed a VTE when using enoxaparin prophylaxis compared with no enoxaparin prophylaxis (2 vs 4%; P = 0.65). Rates of deep vein thrombosis (2 vs 3%; P = 0.87) and pulmonary embolism (0 vs 1%; P = 0.99) were similar between treatment groups, respectively. Late enoxaparin prophylaxis did not demonstrate a protective effect for VTE. Given the overall low event rate, the administration of pharmacologic prophylaxis against VTE late in the treatment course may not be routinely warranted after craniotomy for acute TBI. Further investigation with early administration of enoxaparin is needed.

scholarly journals A Stitch in Time Saves Clots: Venous Thromboembolism Chemoprophylaxis in Traumatic Brain Injury

2021 ◽  
Vol 258 ◽  
pp. 289-298
Author(s):  
Julia R. Coleman ◽  
Heather Carmichael ◽  
Tessa Zangara ◽  
Julie Dunn ◽  
Thomas J. Schroeppel ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Venous Thromboembolism ◽  
Brain Injury
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