Early Venous Thromboembolism Chemoprophylaxis After Traumatic Intracranial Hemorrhage

Frisoli, Fabio A; Shinseki, Matthew; Nwabuobi, Lynda; Zeng, Xiaopei L.; Adrados, Murillo; Kanter, Carolyn; Frangos, Spiros G.; Huang, Paul P.

doi:10.1093/neuros/nyx164

Cited by 20 publications

(13 citation statements)

References 20 publications

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“…12 Other studies, albeit small and lacking generalizability, have reported no new or worsening intracranial hemorrhage in TBI patients if chemoprophylaxis is started as early as 48 hours after admission. 8,9,[13][14][15][16][17][18] Our study is the only one to date that evaluates outcomes based on 7 hour follow-up CT scan and initiation of chemoprophylaxis within 24 hours of injury. It adds to the body of evidence in this area by demonstrating that chemoprophylaxis can be safely started less than 24 hours following injury.…”

Section: Discussionmentioning

confidence: 99%

Early Chemoprophylaxis Against Venous Thromboembolism in Patients With Traumatic Brain Injury

Rivas

Vella

et al. 2021

The American Surgeon™

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Introduction Timing to start of chemoprophylaxis for venous thromboembolism (VTE) in patients with traumatic brain injury (TBI) remains controversial. We hypothesize that early administration is not associated with increased intracranial hemorrhage. Methods A retrospective study of adult patients with TBI following blunt injury was performed. Patients with penetrating brain injury, any moderate/severe organ injury other than the brain, need for craniotomy/craniectomy, death within 24 hours of admission, or progression of bleed on 6 hour follow-up head computed tomography scan were excluded. Patients were divided into early (≤24 hours) and late (>24 hours) cohorts based on time to initiation of chemoprophylaxis. Progression of bleed was the primary outcome. Results 264 patients were enrolled, 40% of whom were in the early cohort. The average time to VTE prophylaxis initiation was 17 hours and 47 hours in the early and late groups, respectively ( P < .0001). There was no difference in progression of bleed (5.6% vs. 7%, P = .67), craniectomy/-craniotomy rate (1.9% vs. 2.5%, P = .81), or VTE rate (0% vs. 2.5%, P = .1). Conclusion Early chemoprophylaxis is not associated with progression of hemorrhage or need for neurosurgical intervention in patients with TBI and a stable head CT 7 hours following injury.

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Section: Discussionmentioning

confidence: 99%

Early Chemoprophylaxis Against Venous Thromboembolism in Patients With Traumatic Brain Injury

Rivas

Vella

et al. 2021

The American Surgeon™

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“…Among 94 intracranial hemorrhage patients started on chemoprophylaxis within 24 hours of admission, there was no difference in rates of radiographic expansion of the hematoma as compared with delayed chemoprophylaxis. 19 The study by Byrne et al in severe TBI patients referenced earlier also looked at safety outcomes and found no increased risk of late neurosurgical intervention or death when prophylaxis was started within 72 hours. 11 Patients with severe TBI, associated intracranial hemorrhage (ICH), and lower GCS were more likely to start chemoprophylaxis in the delayed time periods within our analysis.…”

Section: Discussionmentioning

confidence: 99%

Early Chemoprophylaxis in Severely Injured Trauma Patients Reduces Risk of Venous Thromboembolism

Hecht

Han

Brandt

et al. 2020

The American Surgeon™

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Background Venous thromboembolism (VTE) remains a serious complication for trauma patients. While early VTE prophylaxis has gained traction, the timing of prophylaxis remains uncertain. We hypothesized that VTE prophylaxis within 24 hours of admission would have lower VTE rates and similar rates of adverse events in seriously injured patients. Methods Trauma patients were included from 32 American College of Surgeons verified Level 1 and 2 trauma centers over a 10-year period. Patients with injury severity score (ISS) <15, death or discharge within 48 hours of arrival, or who received no prophylaxis were excluded. Results 14 096 patients received VTE prophylaxis with an ISS of ≥15. Patients given prophylaxis at <24 hours had fewer VTE events and trended toward fewer serious in-hospital complications. Mortality and return to the operating room were similar across groups. Hospital and intensive care unit length of stay in the <24 hours prophylaxis group was significantly shorter when VTE prophylaxis was initiated earlier. Conclusions In severely injured trauma patients with ISS >15, early VTE prophylaxis within 24 hours significantly reduced the risk of VTE as compared with delayed prophylaxis. Early chemoprophylaxis was found to be efficacious in reducing the incidence of VTE; however, the safety of this practice should be evaluated by future prospective studies.

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“…Although patients with TBI have an increased risk of VTE 63,64 , anticoagulant thromboprophylaxis is often delayed because of concerns about progression of intracranial bleeding (ICB). One study reported a greater risk of ICB associated with early anticoagulant thromboprophylaxis 65 , while the vast majority did not 33,57,62,66-71 . Among 1,803 patients with moderate or severe TBI (head Abbreviated Injury Scale > 2), those who started anticoagulant thromboprophylaxis within 48 hours after injury were three times less likely to develop VTE than those who started later without increased bleeding risk 33 .…”

Section: - What Is the Optimal Vte Prophylaxis For Polytrauma Patient...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Trauma

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Trauma Delegates* 1 -What is the most optimal VTE prophylaxis in patients with multiple orthopaedic injuries?Response/Recommendation: Although multiple forms of prophylaxis against venous thromboembolism (VTE) with variable effectiveness are available for patients with multiple orthopedic injuries, low-molecular-weight heparin (LMWH) is considered the most optimal choice based on available literature.Strength of Recommendation: Acceptable.Delegates vote: Agree 86.36% Disagree 9.09% Abstain 4.55% (Strong Consensus).Rationale: VTE events following multiple orthopaedic injuries are associated with significant morbidity and mortality 1,2 . The prevalence of deep venous thrombosis (DVT) in trauma patients without prophylactic treatment can reach up to 60%. Pulmonary embolism (PE) can be a fatal form of VTE with prevalence ranging between 2 -16% 3,4 . VTE can be prevented using different mechanical and chemical prophylaxis agents, therefore, significantly lower the burden on healthcare systems worldwide 1 . The aim of this review is to find the most optimal VTE prophylaxis in patients with multiple orthopaedic injuries.Multiple orthopaedic injuries rarely happen without extraskeletal injuries, therefore, no studies in the current literature addressed VTE prophylaxis in patients with multiple orthopaedic injuries but without extra-skeletal injuries. Most of the available literature is addressing this patient population under different groups including, patients with trauma, poly-trauma, high energy fractures and lower extremity injuries [1][2][3][5][6][7] . The level of evidence varies among the reviewed literature, however, randomized controlled clinical trials in this subject are limited 3,4 .Based on our review, LMWH is considered the most optimal VTE prophylaxis in patients with multiple orthopaedic injuries 1,3,5,6,[8][9][10][11][12][13][14] . Ley et al., recommends using LMWH due to its increased bioavailability, acceptably low bleeding complications and longer plasma half-life 1 . Rogers et al., published in their guidelines for prevention of VTE in trauma patients that LMWH has superior bioavailability when compared to lowdose heparin (LDH) 5 . Knudson et al., concluded in a prospective, randomized trial that LMWH is an extremely effective *A list of the ICM-VTE Trauma Delegates is included in a note at the end of the article. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G855).

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Early Venous Thromboembolism Chemoprophylaxis After Traumatic Intracranial Hemorrhage

Abstract: Early (<24 h) initiation of VTE chemoprophylaxis in patients with traumatic intracranial hemorrhage appears to be safe. Further prospective studies are needed to validate this finding.

Cited by 20 publications

References 20 publications

Early Chemoprophylaxis Against Venous Thromboembolism in Patients With Traumatic Brain Injury

Early Chemoprophylaxis Against Venous Thromboembolism in Patients With Traumatic Brain Injury

Early Chemoprophylaxis in Severely Injured Trauma Patients Reduces Risk of Venous Thromboembolism

Recommendations from the ICM-VTE: Trauma

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