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Pharmacologic venous thromboembolism prophylaxis after TBI: A critical literature review.
MedLine Citation:
PMID:  22651698     Owner:  NLM     Status:  Publisher    
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 forthcoming. 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 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 will critique those studies which 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 subsequently tailors a unique VTE prophylaxis regimen to each individual arm. Key words: traumatic brain injury; venous thromboembolism; prophylaxis; anticoagulant; review.
Authors:
Herb Arthur Phelan
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-31
Journal Detail:
Title:  Journal of neurotrauma     Volume:  -     ISSN:  1557-9042     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-6-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8811626     Medline TA:  J Neurotrauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
UT Southwestern Medical Center, Surgery, 5323 Harry Hines Blvd., E5.508A, Dallas, Texas, United States, 75390-9158, 214-648-6841, 214-648-5477; herb.phelan@utsouthwestern.edu.
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