Document Detail


Chemical venous thromboembolic prophylaxis is safe and effective for patients with traumatic brain injury when started 24 hours after the absence of hemorrhage progression on head CT.
MedLine Citation:
PMID:  22846950     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Venous thromboembolism (VTE) continues to be an important complication for patients with trauma, including patients with intracranial hemorrhage. We implemented a protocol starting chemical prophylaxis 24 hours after the absence of progression of hemorrhage on computed tomography (CT) to increase consistency with the use of chemical venous thromboembolic prophylaxis in this population. The objective of this study was to review the protocol of VTE prophylaxis for patients with traumatic brain injury at our institution to determine whether it has been effective and safe in preventing VTE without increasing intracranial hemorrhage.
METHODS: A retrospective case series was conducted to study 205 patients with intracranial hemorrhage admitted to a Level I trauma center during a 24-month period. These patients were reviewed with respect to type of intracranial injury, need for surgery, injury severity, time to initiation of chemical prophylaxis, and progression of injury on brain CT. Patients with a hospital length of stay less than 3 days or nonstable CT were excluded in the analysis of administration of chemical prophylaxis. Time to chemical prophylaxis in relation to absence of progression on brain CT was examined as well as the subsequent risk of progression of hemorrhage and risk of VTE events. The overall rate of venous thromboembolism was compared with that of matched historical controls.
RESULTS: All patients received mechanical prophylaxis in the form of sequential compression devices. One hundred sixty-two intracranial hemorrhages were identified in 122 patients who met the study's inclusion criteria. Of this group of patients who did not have progression of hemorrhage on follow-up CT, 76.2% received chemical prophylaxis during their hospitalization.No patients had progression of intracranial hemorrhage after initiation of chemical VTE prophylaxis, and no patients developed VTE. This represents a decrease of VTE from previous years. No other complications related to chemical VTE prophylaxis were identified.
CONCLUSION: A protocol based on an early use of chemical venous thromboembolic prophylaxis after the absence of progression of tramatic intracranial hemorrhage does not result in increased progression of intracranial hemorrhage and reduced the rate of venous thromboembolic events at our institution.
Authors:
Yamaan Saadeh; Kartik Gohil; Charles Bill; Curtis Smith; Chet Morrison; Benjamin Mosher; Paul Schneider; Penny Stevens; John P Kepros
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  73     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-31     Completed Date:  2012-10-18     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  426-30     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Michigan State University, Lansing, Michigan 48912, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anticoagulants / therapeutic use*
Brain Injuries / complications,  mortality,  radiography,  therapy
Disease Progression
Female
Follow-Up Studies
Hospital Mortality / trends
Humans
Injury Severity Score
Intracranial Hemorrhages / complications*,  mortality,  radiography,  therapy
Male
Middle Aged
Monitoring, Physiologic / methods
Patient Safety
Primary Prevention / methods*
Risk Assessment
Secondary Prevention
Survival Rate
Tomography, X-Ray Computed / methods
Treatment Outcome
Venous Thromboembolism / etiology,  mortality*,  prevention & control*
Young Adult
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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