| Pharmacologic thromboprophylaxis is a risk factor for hemorrhage progression in a subset of patients with traumatic brain injury. | |
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MedLine Citation:
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PMID: 20386284 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Pharmacologic thromboprophylaxis (PTP) may exacerbate intracranial hemorrhage (ICH) in patients with traumatic brain injury (TBI). We examined risk factors for hemorrhage progression in patients with blunt TBI and hypothesized that PTP would increase ICH progression in a subset of these patients. METHODS: We retrospectively studied patients with TBI admitted to our level I trauma center during 19 months. Progression of hemorrhage was examined in two populations: patients with a stable initial follow-up (F/U) computed tomography (CT) and patients with hemorrhage progression on initial F/U CT. Risk factors potentially associated with hemorrhage progression were analyzed using logistic regression. Timing of PTP was defined two ways: exposed to PTP versus not exposed; early (<72 hours), late (>or=72 hours), or no PTP. RESULTS: Three hundred forty patients with TBI were reviewed and hemorrhage progression occurred in 32.4% (n = 110) of patients of which 59.1% were considered clinically significant. In patients with ICH progression on initial F/U CT, predictors of subsequent hemorrhage progression include exposure to PTP (odds ratio [OR]: 13.07, p = 0.01), extradural/subdural hemorrhage (OR: 5.15, p = 0.03), Glasgow Coma Score 3-8 (OR: 4.64, p = 0.03), and body mass index >or=25 (OR = 4.32, p = 0.03). PTP was not significantly associated with hemorrhage progression in patients with a stable initial F/U CT. CONCLUSIONS: These findings suggest that PTP use is associated with a 13-fold increased odds of further hemorrhage progression in patients whose F/U CT within 1 day of admission showed ICH progression; 16% of this risk can be attributed to receiving PTP. Conversely, PTP may be safe in a subgroup of patients with TBI with no ICH progression on initial F/U CT. |
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Authors:
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Andrew Stewart Levy; Kristin Salottolo; Raphael Bar-Or; Patrick Offner; Charles Mains; Michael Sullivan; David Bar-Or |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of trauma Volume: 68 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-04-13 Completed Date: 2010-05-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: 886-94 Citation Subset: AIM; IM |
Affiliation:
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InterMountain Neurosurgery, St. Anthony Central Hospital, Denver, Colorado, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Brain Injuries
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complications*,
radiography Chi-Square Distribution Disease Progression Female Humans Intracranial Hemorrhages / etiology*, physiopathology, prevention & control*, radiography Length of Stay / statistics & numerical data Logistic Models Male Middle Aged Predictive Value of Tests Retrospective Studies Risk Factors Statistics, Nonparametric Thrombolytic Therapy / adverse effects* Tomography, X-Ray Computed |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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