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Safety and Efficacy of Early Pharmacologic Thromboprophylaxis in Traumatic Brain Injury
Abstract
Background: Patients with traumatic brain injury (TBI) are at an increased risk of developing venous thromboembolic events (VTE), including deep vein thromboses (DVT) and pulmonary emboli (PE). Pharmacologic thromboprophylaxis (PTP) is routinely delayed because of concerns of exacerbating intracranial hemorrhage (ICH) and worsening outcomes. We hypothesize that early PTP (< 72 h) in TBI reduces the risk of VTE without affecting progression of ICH or worsening outcomes as compared to late PTP (> 72 h).
Methods: We identified a total of 128 TBI patients who received PTP, and collected data including admission Glasgow coma scale (GCS), age, time of initiation of PTP, development of DVT or PE, progression of bleed on brain CT scan, death attributed to PTP and outcome (Glasgow outcome scale (GOS) at discharge from the hospital).
Results: The < 72 h group (n = 80) had an average GCS of 13.6 (± 1.8) and age of 50 (± 21) yrs compared to GCS of 11 (± 3.8) (P = 0.0001) and age of 43 (± 18) (P = 0.06) in the > 72 h group (n = 48). The < 72 h group developed 8 (10%) DVTs compared with 13 (27%) DVTs in the > 72 h group (odds ratio (OR) = 0.3; 95% confidence interval (CI) = 0.1 - 0.7, P = 0.01). There were no PEs, progression on brain CT, or deaths attributed to PTP in either group. Good neurologic outcome (GOS 4-5) was present in 35 (44%) patients in the < 72 h group compared to 11 (23%) patients in the > 72 h group (OR = 2.6, 95% CI = 1.2 - 5.8, P = 0.01) (This outcome was expected and explained by the higher admission GCS in the < 72 h group).
Conclusions: In our study, early PTP (< 72 h) in TBI significantly reduced the risk of VTE without affecting progression of ICH or worsening outcome as compared to late PTP (> 72 h). However, the safety and feasibility of early PTP in TBI still needs to be studied in large prospective multicenter trials, taking into account the severity of TBI, type of TBI (focal versus diffuse axonal injury), and type and dosage of PTP.
J Neurol Res. 2013;3(6):169-172
doi: http://dx.doi.org/10.4021/jnr255w
Methods: We identified a total of 128 TBI patients who received PTP, and collected data including admission Glasgow coma scale (GCS), age, time of initiation of PTP, development of DVT or PE, progression of bleed on brain CT scan, death attributed to PTP and outcome (Glasgow outcome scale (GOS) at discharge from the hospital).
Results: The < 72 h group (n = 80) had an average GCS of 13.6 (± 1.8) and age of 50 (± 21) yrs compared to GCS of 11 (± 3.8) (P = 0.0001) and age of 43 (± 18) (P = 0.06) in the > 72 h group (n = 48). The < 72 h group developed 8 (10%) DVTs compared with 13 (27%) DVTs in the > 72 h group (odds ratio (OR) = 0.3; 95% confidence interval (CI) = 0.1 - 0.7, P = 0.01). There were no PEs, progression on brain CT, or deaths attributed to PTP in either group. Good neurologic outcome (GOS 4-5) was present in 35 (44%) patients in the < 72 h group compared to 11 (23%) patients in the > 72 h group (OR = 2.6, 95% CI = 1.2 - 5.8, P = 0.01) (This outcome was expected and explained by the higher admission GCS in the < 72 h group).
Conclusions: In our study, early PTP (< 72 h) in TBI significantly reduced the risk of VTE without affecting progression of ICH or worsening outcome as compared to late PTP (> 72 h). However, the safety and feasibility of early PTP in TBI still needs to be studied in large prospective multicenter trials, taking into account the severity of TBI, type of TBI (focal versus diffuse axonal injury), and type and dosage of PTP.
J Neurol Res. 2013;3(6):169-172
doi: http://dx.doi.org/10.4021/jnr255w
Keywords
Coma; Traumatic brain injury; TBI; Thromboprophylaxis; DVT; PE; Deep vein thrombosis; Pulmonary embolus; Chemoprophylaxis