Document Detail

Pharmacologic thromboprophylaxis is a risk factor for hemorrhage progression in a subset of patients with traumatic brain injury.
MedLine Citation:
PMID:  20386284     Owner:  NLM     Status:  MEDLINE    
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.
Andrew Stewart Levy; Kristin Salottolo; Raphael Bar-Or; Patrick Offner; Charles Mains; Michael Sullivan; David Bar-Or
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of trauma     Volume:  68     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-13     Completed Date:  2010-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  886-94     Citation Subset:  AIM; IM    
InterMountain Neurosurgery, St. Anthony Central Hospital, Denver, Colorado, USA.
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MeSH Terms
Brain Injuries / complications*,  radiography
Chi-Square Distribution
Disease Progression
Intracranial Hemorrhages / etiology*,  physiopathology,  prevention & control*,  radiography
Length of Stay / statistics & numerical data
Logistic Models
Middle Aged
Predictive Value of Tests
Retrospective Studies
Risk Factors
Statistics, Nonparametric
Thrombolytic Therapy / adverse effects*
Tomography, X-Ray Computed

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