Author:
Ratnasekera Asanthi M.,Kim Daniel,Seng Sirivan S.,Jacovides Christina,Kaufman Elinore J.,Sadek Hannah M.,Perea Lindsey L.,Monaco Christina,Shnaydman Ilya,Lee Alexandra Jeongyoon,Sharp Victoria,Miciura Angela,Trevizo Eric,Rosenthal Martin,Lottenberg Lawrence,Zhao William,Keininger Alicia,Hunt Michele,Cull John,Balentine Chassidy,Egodage Tanya,Mohamed Aleem,Kincaid Michelle,Doris Stephanie,Cotterman Robert,Seegert Sara,Jacobson Lewis E.,Williams Jamie,Whitmill Melissa,Palmer Brandi,Mentzer Caleb,Tackett Nichole,Hranjec Tjasa,Dougherty Thomas,Morrissey Shawna,Donatelli-Seyler Lauren,Rushing Amy,Tatebe Leah C.,Nevill Tiffany J.,Aboutanos Michel B.,Hamilton David,Redmond Diane,Cullinane Daniel C.,Falank Carolyne,McMellen Mark,Duran Christ,Daniels Jennifer,Ballow Shana,Schuster Kevin,Ferrada Paula
Abstract
BACKGROUND
Patients with traumatic brain injury (TBI) are at high risk of venous thromboembolism events (VTE). We hypothesized that early chemical VTE prophylaxis initiation (≤24 hours of a stable head CT) in severe TBI would reduce VTE without increasing risk of intracranial hemorrhage expansion (ICHE).
METHODS
A retrospective review of adult patients 18 years or older with isolated severe TBI (Abbreviated Injury Scale score, ≥ 3) who were admitted to 24 Level I and Level II trauma centers from January 1, 2014 to December 31 2020 was conducted. Patients were divided into those who did not receive any VTE prophylaxis (NO VTEP), who received VTE prophylaxis ≤24 hours after stable head CT (VTEP ≤24) and who received VTE prophylaxis >24 hours after stable head CT (VTEP>24). Primary outcomes were VTE and ICHE. Covariate balancing propensity score weighting was utilized to balance demographic and clinical characteristics across three groups. Weighted univariate logistic regression models were estimated for VTE and ICHE with patient group as predictor of interest.
RESULTS
Of 3,936 patients, 1,784 met inclusion criteria. Incidences of VTE was significantly higher in the VTEP>24 group, with higher incidences of DVT in the group. Higher incidences of ICHE were observed in the VTEP≤24 and VTEP>24 groups. After propensity score weighting, there was a higher risk of VTE in patients in VTEP >24 compared with those in VTEP≤24 (odds ratio, 1.51; 95% confidence interval, 0.69–3.30; p = 0.307), however was not significant. Although, the No VTEP group had decreased odds of having ICHE compared with VTEP≤24 (odds ratio, 0.75; 95% confidence interval, 0.55–1.02, p = 0.070), the result was not statistically significant.
CONCLUSION
In this large multi-center analysis, there were no significant differences in VTE based on timing of initiation of VTE prophylaxis. Patients who never received VTE prophylaxis had decreased odds of ICHE. Further evaluation of VTE prophylaxis in larger randomized studies will be necessary for definitive conclusions.
LEVEL OF EVIDENCE
Therapeutic Care Management; Level III.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Critical Care and Intensive Care Medicine,Surgery
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