Timing of venous thromboembolic pharmacological prophylaxis in traumatic combined subdural and subarachnoid hemorrhage

Jakob, Dominik A.; Lewis, Meghan; Benjamin, Elizabeth; Mitchao, Delbrynth P.; Exadaktylos, Aristomenis K.; Δημητριάδης, Δημήτριος

doi:10.1016/j.amjsurg.2021.11.021

Cited by 8 publications

(4 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients with TBI, such as that in the present case, the early introduction of prophylaxis (≤48 hours) can minimise the risks of developing severe DVT without increasing haemorrhagic complications 6 7…”

Section: Discussionmentioning

confidence: 86%

Phlegmasia cerulea dolens: a swelling, cyanosis and discolouration of the extremity in the ICU

et al. 2022

View full text Add to dashboard Cite

Phlegmasia cerulea dolens is a rare entity that causes critical limb ischaemia, which may lead to amputation of the limb and may be life-threatening. Here, we describe a case of a healthy man in his 50s with multiple trauma who was transferred to the intensive care unit (ICU) of a central hospital for neuromonitoring following splenectomy for the stabilisation of a hypovolaemic shock. On admission to the ICU, the patient developed a swollen and white leg. The condition was caused by early compromised arterial flow secondary to extensive deep vein thrombosis.

show abstract

Section: Discussionmentioning

confidence: 86%

Phlegmasia cerulea dolens: a swelling, cyanosis and discolouration of the extremity in the ICU

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The American College of Surgeons state in its best practice guidelines for the management of TBI that in most cases, VTE prophylaxis should be considered within the first 72 h after TBI [ 28 ]. However, several recently published studies evaluated a more aggressive VTE prophylaxis in TBI patients and concluded that VTE prophylaxis within 48 h of admission is safe and effective in preventing VTE complications in TBI patients [ 29 – 33 ]. As a consequence of the increased VTE risk in penetrating as compared to blunt TBI an even more aggressive VTE prophylaxis might be appropriate.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for thromboembolic complications in isolated severe head injury

Jakob

Mûller

Lewis

et al. 2023

Eur J Trauma Emerg Surg

Self Cite

View full text Add to dashboard Cite

Purpose Patients with traumatic brain injury (TBI) are at high risk for venous thromboembolism (VTE). The aim of the present study is to identify factors independently associated with VTE events. Specifically, we hypothesized that the mechanism of penetrating head trauma might be an independent factor associated with increased VTE events when compared with blunt head trauma. Methods The ACS-TQIP database (2013–2019) was queried for all patients with isolated severe head injuries (AIS 3–5) who received VTE prophylaxis with either unfractionated heparin or low-molecular-weight heparin. Transfers, patients who died within 72 h and those with a hospital length of stay < 48 h were excluded. Multivariable analysis was used as the primary analysis to identify independent risk factors for VTE in isolated severe TBI. Results A total of 75,570 patients were included in the study, 71,593 (94.7%) with blunt and 3977 (5.3%) with penetrating isolated TBI. Penetrating trauma mechanism (OR 1.49, CI 95% 1.26–1.77), increasing age (age 16–45: reference; age > 45–65: OR 1.65, CI 95% 1.48–1.85; age > 65–75: OR 1.71, CI 95% 1.45–2.02; age > 75: OR 1.73, CI 95% 1.44–2.07), male gender (OR 1.53, CI 95% 1.36–1.72), obesity (OR 1.35, CI 95% 1.22–1.51), tachycardia (OR 1.31, CI 95% 1.13–1.51), increasing head AIS (AIS 3: reference; AIS 4: OR 1.52, CI 95% 1.35–1.72; AIS 5: OR 1.76, CI 95% 1.54–2.01), associated moderate injuries (AIS = 2) of the abdomen (OR 1.31, CI 95% 1.04–1.66), spine (OR 1.35, CI 95% 1.19–1.53), upper extremity (OR 1.16, CI 95% 1.02–1.31), lower extremity (OR 1.46, CI 95% 1.26–1.68), craniectomy/craniotomy or ICP monitoring (OR 2.96, CI 95% 2.65–3.31) and pre-existing hypertension (OR 1.18, CI 95% 1.05–1.32) were identified as independent risk factors for VTE complications in isolated severe head injury. Increasing GCS (OR 0.93, CI 95% 0.92–0.94), early VTE prophylaxis (OR 0.48, CI 95% 0.39–0.60) and LMWH compared to heparin (OR 0.74, CI 95% 0.68–0.82) were identified as protective factors for VTE complications. Conclusion The identified factors independently associated with VTE events in isolated severe TBI need to be considered in VTE prevention measures. In penetrating TBI, an even more aggressive VTE prophylaxis management may be justified as compared to that in blunt.

show abstract

“…At the same time, they are also at risk of intracranial bleeding or progression of intracranial haemorrhage. Several retrospective studies have shown that early pharmacological prophylaxis (< 48 h) is effective in reducing VTE without increasing the risk of intracranial haemorrhage in patients where progression of intracranial haemorrhage has been excluded 37–41 . In patients needing urgent neurosurgery (craniotomy, craniectomy or intracranial monitor or drain insertion), the probability of VTE increased with longer delays in pharmacological prophylaxis, but earlier prophylaxis was associated with a greater probability of repeated neurosurgery 42 .…”

Section: Traumatic Brain Injury/spinal Cord Injurymentioning

confidence: 99%

“…Several retrospective studies have shown that early pharmacological prophylaxis (< 48 h) is effective in reducing VTE without increasing the risk of intracranial haemorrhage in patients where progression of intracranial haemorrhage has been excluded. [37][38][39][40][41] In patients needing urgent neurosurgery (craniotomy, craniectomy or intracranial monitor or drain insertion), the probability of VTE increased with longer delays in pharmacological prophylaxis, but earlier prophylaxis was associated with a greater probability of repeated neurosurgery. 42 Hence, the risk/benefit ratio of pharmacological prophylaxis is uncertain and needs individual assessment of VTE and intracranial bleeding risks.…”

Section: Traumatic Brain Injury/spinal Cord Injury Rationalementioning

confidence: 99%

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

Heim,

Bruder,

Davenport

et al. 2024

European Journal of Anaesthesiology

View full text Add to dashboard Cite

Monitoring hypercoagulation in trauma patients RationaleIt is now well recognised that in the acute phase, after major trauma, the coagulation system is dynamic and, particularly in bleeding patients with trauma-induced coagulopathy or severe brain injury, a hypercoagulable phenotype develops universally within 24 to 48 h. 1 Achieving adequate venous thromboembolism prophylaxis (VTEp) in trauma patients remains challenging for several reasons and despite standardised protocols to administer low-molecular-weight heparin (LMWH), up to 18% of critically injured patients will develop deep venous thrombosis (DVT) or pulmonary embolism despite pharmacoprophylaxis. 2 Measuring serum anti-Xa levels has been proposed to help titrate VTEp, with consensus defining prophylactic anti-Xa levels as 0.2 to 0.4 IU ml À1 for peak measurements or 0.1 to 0.2 IU ml À1 for trough levels, with values below this being subprophylactic. 3 Studies have shown that prophylactic anti-Xa levels compared with subprophylactic levels predict the risk of a clinically significant VTE in trauma patients. [4][5][6] Two studies have reported that anti-Xa-guided dosing of LMWH reduces the rate of VTE after trauma compared with a standard fixed dose of enoxaparin. 7,8 However, a more recent large single centre study has failed to show any benefit of anti-Xa guided dosing for VTEp. 9 Weight-adjusted protocols for LMWH are used in published guidelines 10 based on a handful of studies demonstrating improved rates of prophylactic anti-FXa levels and overall lower VTE rates.

show abstract

Timing of venous thromboembolic pharmacological prophylaxis in traumatic combined subdural and subarachnoid hemorrhage

Cited by 8 publications

References 28 publications

Phlegmasia cerulea dolens: a swelling, cyanosis and discolouration of the extremity in the ICU

Phlegmasia cerulea dolens: a swelling, cyanosis and discolouration of the extremity in the ICU

Risk factors for thromboembolic complications in isolated severe head injury

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.

Contact Info

Product

Resources

About