Document Detail


Pharmacologic venous thromboembolism prophylaxis after traumatic brain injury: a critical literature review.
MedLine Citation:
PMID:  22651698     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Despite the frequency and morbidity of venous thromboembolism (VTE) development after traumatic brain injury (TBI), no national standard of care exists to guide TBI caregivers for the use of prophylactic anticoagulation. Fears of iatrogenic propagation of intracranial hemorrhage patterns have led to a dearth of research in this field, and it is only relatively recently that studies dedicated to this question have been performed. These have generally been limited to retrospective and/or observational studies in which patients are classified in a binary fashion as having the presence or absence of intracranial blood. This methodology does not account for the fact that smaller injury patterns stabilize more rapidly, and thus may be able to safely tolerate earlier initiation of prophylactic anticoagulation than larger injury patterns. This review seeks to critically assess the literature on this question by examining the existing evidence on the safety and efficacy of pharmacologic VTE prophylaxis in the setting of elective craniotomy (as this is the closest model available from which to extrapolate) and after TBI. In doing so, we critique studies that approach TBI as a homogenous or a heterogenous study population. Finally, we propose our own theoretical protocol which stratifies patients into low, moderate, and high risk for the likelihood of natural progression of their hemorrhage pattern, and which allows one to tailor a unique VTE prophylaxis regimen to each individual arm.
Authors:
Herb A Phelan
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Journal of neurotrauma     Volume:  29     ISSN:  1557-9042     ISO Abbreviation:  J. Neurotrauma     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-10     Completed Date:  2013-05-22     Revised Date:  2013-06-24    
Medline Journal Info:
Nlm Unique ID:  8811626     Medline TA:  J Neurotrauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1821-8     Citation Subset:  IM    
Affiliation:
Division of Burns/Trauma/Critical Care, Department of Surgery, University of Texas-Southwestern Medical Center, Dallas, TX 75390-9158, USA. herb.phelan@utsouthwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / administration & dosage*,  adverse effects*
Brain Injuries / complications*,  physiopathology
Craniotomy / adverse effects,  standards
Evidence-Based Medicine / standards
Humans
Intracranial Hemorrhages / chemically induced,  diagnosis,  prevention & control
Venous Thromboembolism / drug therapy*,  etiology*,  prevention & control
Grant Support
ID/Acronym/Agency:
1 KL2 RR024983-01/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Anticoagulants
Comments/Corrections

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