Retrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injury
Background: Traumatic brain injury (TBI) is a risk factor for venous thromboembolism (VTE) but few studies address optimal timing or choice of agent. Materials and Methods: Retrospective review of moderate to severe TBI patients receiving chemical VTE prophylaxis (early initiation [≤ 72 h from admis...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | Surgery in Practice and Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666262023000141 |
| _version_ | 1797809771217158144 |
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| author | Emily K. Hollfelder Stephen Rappaport Julius Cheng Jignesh H. Patel |
| author_facet | Emily K. Hollfelder Stephen Rappaport Julius Cheng Jignesh H. Patel |
| author_sort | Emily K. Hollfelder |
| collection | DOAJ |
| description | Background: Traumatic brain injury (TBI) is a risk factor for venous thromboembolism (VTE) but few studies address optimal timing or choice of agent. Materials and Methods: Retrospective review of moderate to severe TBI patients receiving chemical VTE prophylaxis (early initiation [≤ 72 h from admission], late [> 72 h to 7 days], or delayed [> 7 days]) between 2012 through 2017. Primary outcome was VTE occurrence. Secondary objectives evaluated intracranial hemorrhage (ICH) requiring cessation of prophylaxis and differences between unfractionated (UFH) and low-molecular weight heparin (LMWH). Results: A total of 198 patients were evaluated; median age was 44 years (IQR 25–60), median Glasgow Coma Scale score 3 (IQR 3–7), and median injury severity score 27 (IQR 22–34). Ten percent of patients (n = 20) developed VTE. Median time to VTE prophylaxis was 81 h (IQR 53–152) and there was no difference in VTE incidence across all groups (p = 0.09). Intergroup comparison showed patients that received early prophylaxis had lower VTE rates (6% vs. 16%, p = 0.04) and mortality (3% vs. 15%, p = 0.02) compared to late initiation (but not delayed). There were no instances of new onset or expanded ICH requiring cessation of prophylaxis. VTE rates for patients receiving UFH only or LMWH only, 14/115 (12.2%) vs. 3/46 (6.5%), were not different (p = 0.4). Mortality was lower in the LMWH only group (0% vs. 13.0%, p<0.01). Conclusions: Initiating VTE prophylaxis within 72 h of moderate to severe TBI appears to be safe and may be associated with lower rates of VTE and mortality. |
| first_indexed | 2024-03-13T06:57:48Z |
| format | Article |
| id | doaj.art-3a5abd822ece4e9cbef81281671d067c |
| institution | Directory Open Access Journal |
| issn | 2666-2620 |
| language | English |
| last_indexed | 2024-03-13T06:57:48Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery in Practice and Science |
| spelling | doaj.art-3a5abd822ece4e9cbef81281671d067c2023-06-07T04:49:47ZengElsevierSurgery in Practice and Science2666-26202023-06-0113100168Retrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injuryEmily K. Hollfelder0Stephen Rappaport1Julius Cheng2Jignesh H. Patel3Department of Pharmacy, Highland Hospital, 1000 South Avenue, Rochester, NY, 14620 United States; Corresponding author.Department of Pharmacy, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642 United StatesDivision of Trauma and Acute Care Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642 United StatesDepartment of Pharmacy, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York, 14642 United States; College of Pharmacy, Western University of Health Sciences, 309 E 2nd St, Pomona, California, 91766, United StatesBackground: Traumatic brain injury (TBI) is a risk factor for venous thromboembolism (VTE) but few studies address optimal timing or choice of agent. Materials and Methods: Retrospective review of moderate to severe TBI patients receiving chemical VTE prophylaxis (early initiation [≤ 72 h from admission], late [> 72 h to 7 days], or delayed [> 7 days]) between 2012 through 2017. Primary outcome was VTE occurrence. Secondary objectives evaluated intracranial hemorrhage (ICH) requiring cessation of prophylaxis and differences between unfractionated (UFH) and low-molecular weight heparin (LMWH). Results: A total of 198 patients were evaluated; median age was 44 years (IQR 25–60), median Glasgow Coma Scale score 3 (IQR 3–7), and median injury severity score 27 (IQR 22–34). Ten percent of patients (n = 20) developed VTE. Median time to VTE prophylaxis was 81 h (IQR 53–152) and there was no difference in VTE incidence across all groups (p = 0.09). Intergroup comparison showed patients that received early prophylaxis had lower VTE rates (6% vs. 16%, p = 0.04) and mortality (3% vs. 15%, p = 0.02) compared to late initiation (but not delayed). There were no instances of new onset or expanded ICH requiring cessation of prophylaxis. VTE rates for patients receiving UFH only or LMWH only, 14/115 (12.2%) vs. 3/46 (6.5%), were not different (p = 0.4). Mortality was lower in the LMWH only group (0% vs. 13.0%, p<0.01). Conclusions: Initiating VTE prophylaxis within 72 h of moderate to severe TBI appears to be safe and may be associated with lower rates of VTE and mortality.http://www.sciencedirect.com/science/article/pii/S2666262023000141Brain injuriesTraumaticVenous thromboembolismAnticoagulantsHeparinHeparin, Low-molecular-weight |
| spellingShingle | Emily K. Hollfelder Stephen Rappaport Julius Cheng Jignesh H. Patel Retrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injury Surgery in Practice and Science Brain injuries Traumatic Venous thromboembolism Anticoagulants Heparin Heparin, Low-molecular-weight |
| title | Retrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injury |
| title_full | Retrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injury |
| title_fullStr | Retrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injury |
| title_full_unstemmed | Retrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injury |
| title_short | Retrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injury |
| title_sort | retrospective evaluation of chemical venous thromboembolism prophylaxis in traumatic brain injury |
| topic | Brain injuries Traumatic Venous thromboembolism Anticoagulants Heparin Heparin, Low-molecular-weight |
| url | http://www.sciencedirect.com/science/article/pii/S2666262023000141 |
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