Safety and efficacy of prophylactic anticoagulation in patients with traumatic brain injury

Travis Scudday, Karen Brasel, Travis Webb, Panna Codner, Lewis Somberg, John Weigelt, David Herrmann, William Peppard

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: Patients with traumatic brain injury (TBI) are at high risk for venous thromboembolism (VTE), but physicians are cautious with chemical prophylaxis in these patients because of concern about exacerbating intracranial hemorrhage. We hypothesized that early use of chemical thromboprophylaxis would reduce VTE incidence without increasing intracranial hemorrhage. Study Design: Records of all patients admitted with a TBI to a Level I trauma center from 2006 to 2008 were reviewed. TBI was defined as intracranial hemorrhage, hematoma, contusion, or diffuse axonal injury with a head Abbreviated Injury Scale score >2. Patients were excluded if they were discharged or died within 72 hours of admission. Chemical prophylaxis was defined as subcutaneous or intravenous unfractionated heparin or low molecular weight heparin before any VTE diagnosis. Progression of TBI was defined by worsening CT findings. VTE was defined as deep venous thrombosis or pulmonary embolus confirmed by radiology reports. Primary outcomes were progression of hemorrhage and VTE events. Results: Eight hundred and twelve of the 1,258 patients admitted to the trauma center with a TBI met study criteria. Chemical thromboprophylaxis was given to 49.5% (n = 402). Mean head Abbreviated Injury Scale score was 3.4 in both groups. One hundred and sixty-nine patients started prophylaxis within 48 hours and 242 patients began within 72 hours. Patients receiving chemical prophylaxis had a lower incidence of VTE (1% versus 3%; p = 0.019). Although not statistically significant, they also had a lower rate of injury progression, 3% versus 6% (p = 0.055). Conclusions: Use of chemical thromboprophylaxis in TBI patients with a stable or improved head CT after 24 hours substantially reduces the incidence of VTE and does not increase the risk of progression of intracranial hemorrhage.

Original languageEnglish (US)
Pages (from-to)148-153
Number of pages6
JournalJournal of the American College of Surgeons
Volume213
Issue number1
DOIs
StatePublished - Jul 2011
Externally publishedYes

Fingerprint

Venous Thromboembolism
Safety
Intracranial Hemorrhages
Abbreviated Injury Scale
Trauma Centers
Craniocerebral Trauma
Incidence
Diffuse Axonal Injury
Traumatic Brain Injury
Contusions
Low Molecular Weight Heparin
Embolism
Radiology
Venous Thrombosis
Hematoma
Heparin
Head
Hemorrhage
Physicians
Lung

Keywords

  • Abbreviated Injury Scale
  • AIS
  • deep vein thrombosis
  • DVT
  • GCS
  • Glasgow Coma Scale
  • Injury Severity Score
  • ISS
  • TBI
  • traumatic brain injury
  • venous thromboembolic event
  • VTE

ASJC Scopus subject areas

  • Surgery

Cite this

Safety and efficacy of prophylactic anticoagulation in patients with traumatic brain injury. / Scudday, Travis; Brasel, Karen; Webb, Travis; Codner, Panna; Somberg, Lewis; Weigelt, John; Herrmann, David; Peppard, William.

In: Journal of the American College of Surgeons, Vol. 213, No. 1, 07.2011, p. 148-153.

Research output: Contribution to journalArticle

Scudday, Travis ; Brasel, Karen ; Webb, Travis ; Codner, Panna ; Somberg, Lewis ; Weigelt, John ; Herrmann, David ; Peppard, William. / Safety and efficacy of prophylactic anticoagulation in patients with traumatic brain injury. In: Journal of the American College of Surgeons. 2011 ; Vol. 213, No. 1. pp. 148-153.
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AU - Brasel, Karen

AU - Webb, Travis

AU - Codner, Panna

AU - Somberg, Lewis

AU - Weigelt, John

AU - Herrmann, David

AU - Peppard, William

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AB - Background: Patients with traumatic brain injury (TBI) are at high risk for venous thromboembolism (VTE), but physicians are cautious with chemical prophylaxis in these patients because of concern about exacerbating intracranial hemorrhage. We hypothesized that early use of chemical thromboprophylaxis would reduce VTE incidence without increasing intracranial hemorrhage. Study Design: Records of all patients admitted with a TBI to a Level I trauma center from 2006 to 2008 were reviewed. TBI was defined as intracranial hemorrhage, hematoma, contusion, or diffuse axonal injury with a head Abbreviated Injury Scale score >2. Patients were excluded if they were discharged or died within 72 hours of admission. Chemical prophylaxis was defined as subcutaneous or intravenous unfractionated heparin or low molecular weight heparin before any VTE diagnosis. Progression of TBI was defined by worsening CT findings. VTE was defined as deep venous thrombosis or pulmonary embolus confirmed by radiology reports. Primary outcomes were progression of hemorrhage and VTE events. Results: Eight hundred and twelve of the 1,258 patients admitted to the trauma center with a TBI met study criteria. Chemical thromboprophylaxis was given to 49.5% (n = 402). Mean head Abbreviated Injury Scale score was 3.4 in both groups. One hundred and sixty-nine patients started prophylaxis within 48 hours and 242 patients began within 72 hours. Patients receiving chemical prophylaxis had a lower incidence of VTE (1% versus 3%; p = 0.019). Although not statistically significant, they also had a lower rate of injury progression, 3% versus 6% (p = 0.055). Conclusions: Use of chemical thromboprophylaxis in TBI patients with a stable or improved head CT after 24 hours substantially reduces the incidence of VTE and does not increase the risk of progression of intracranial hemorrhage.

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KW - venous thromboembolic event

KW - VTE

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