Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury: A prospective observational study and systematic review of the literature

Laureen D. Hachem, Seyed Alireza Mansouri, Damon C. Scales, William Geerts, Farhad Pirouzmand

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: Venous thromboembolism (VTE) is a serious complication following severe traumatic brain injury (TBI), however, anticoagulant prophylaxis remains controversial due to concerns of intracranial hemorrhage (ICH) progression. We examined anticoagulant prophylaxis practice patterns at a major trauma centre and determined risk estimates for VTE and ICH progression classified by timing of anticoagulant initiation. Patients and methods: A 1-year prospective analysis of consecutive patients with severe TBI admitted to a Level-I trauma centre was conducted. In addition, we systematically reviewed the literature to identify studies on VTE and anticoagulant prophylaxis after severe TBI. Results: 64 severe TBI patients were included. 83% of patients received anticoagulant prophylaxis, initiated ≥3d post-TBI in 67%. The in-hospital VTE incidence was 16% and there was no significant difference between patients who received early (<3d) versus late (≥3d) prophylaxis (10% vs. 16%). Rates of ICH progression (0% vs. 7%) were similar between groups. Our systematic review identified 5 studies with VTE rates ranging from 5 to 10% with prophylaxis, to 11–30% without prophylaxis. The effect of timing of anticoagulant prophylaxis initiation on ICH progression was not reported in any study. Conclusion: VTE is a common complication after severe TBI. Anticoagulant prophylaxis is often started late (≥3d) post-injury. Randomized trials are justifiable and necessary to provide practice guidance with regards to optimal timing of anticoagulant prophylaxis.

Original languageEnglish (US)
Pages (from-to)68-73
Number of pages6
JournalClinical Neurology and Neurosurgery
Volume175
DOIs
StatePublished - Dec 1 2018

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Venous Thromboembolism
Anticoagulants
Observational Studies
Prospective Studies
Intracranial Hemorrhages
Trauma Centers
Traumatic Brain Injury
Incidence
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

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title = "Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury: A prospective observational study and systematic review of the literature",
abstract = "Objectives: Venous thromboembolism (VTE) is a serious complication following severe traumatic brain injury (TBI), however, anticoagulant prophylaxis remains controversial due to concerns of intracranial hemorrhage (ICH) progression. We examined anticoagulant prophylaxis practice patterns at a major trauma centre and determined risk estimates for VTE and ICH progression classified by timing of anticoagulant initiation. Patients and methods: A 1-year prospective analysis of consecutive patients with severe TBI admitted to a Level-I trauma centre was conducted. In addition, we systematically reviewed the literature to identify studies on VTE and anticoagulant prophylaxis after severe TBI. Results: 64 severe TBI patients were included. 83{\%} of patients received anticoagulant prophylaxis, initiated ≥3d post-TBI in 67{\%}. The in-hospital VTE incidence was 16{\%} and there was no significant difference between patients who received early (<3d) versus late (≥3d) prophylaxis (10{\%} vs. 16{\%}). Rates of ICH progression (0{\%} vs. 7{\%}) were similar between groups. Our systematic review identified 5 studies with VTE rates ranging from 5 to 10{\%} with prophylaxis, to 11–30{\%} without prophylaxis. The effect of timing of anticoagulant prophylaxis initiation on ICH progression was not reported in any study. Conclusion: VTE is a common complication after severe TBI. Anticoagulant prophylaxis is often started late (≥3d) post-injury. Randomized trials are justifiable and necessary to provide practice guidance with regards to optimal timing of anticoagulant prophylaxis.",
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Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury : A prospective observational study and systematic review of the literature. / Hachem, Laureen D.; Mansouri, Seyed Alireza; Scales, Damon C.; Geerts, William; Pirouzmand, Farhad.

In: Clinical Neurology and Neurosurgery, Vol. 175, 01.12.2018, p. 68-73.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury

T2 - A prospective observational study and systematic review of the literature

AU - Hachem, Laureen D.

AU - Mansouri, Seyed Alireza

AU - Scales, Damon C.

AU - Geerts, William

AU - Pirouzmand, Farhad

PY - 2018/12/1

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N2 - Objectives: Venous thromboembolism (VTE) is a serious complication following severe traumatic brain injury (TBI), however, anticoagulant prophylaxis remains controversial due to concerns of intracranial hemorrhage (ICH) progression. We examined anticoagulant prophylaxis practice patterns at a major trauma centre and determined risk estimates for VTE and ICH progression classified by timing of anticoagulant initiation. Patients and methods: A 1-year prospective analysis of consecutive patients with severe TBI admitted to a Level-I trauma centre was conducted. In addition, we systematically reviewed the literature to identify studies on VTE and anticoagulant prophylaxis after severe TBI. Results: 64 severe TBI patients were included. 83% of patients received anticoagulant prophylaxis, initiated ≥3d post-TBI in 67%. The in-hospital VTE incidence was 16% and there was no significant difference between patients who received early (<3d) versus late (≥3d) prophylaxis (10% vs. 16%). Rates of ICH progression (0% vs. 7%) were similar between groups. Our systematic review identified 5 studies with VTE rates ranging from 5 to 10% with prophylaxis, to 11–30% without prophylaxis. The effect of timing of anticoagulant prophylaxis initiation on ICH progression was not reported in any study. Conclusion: VTE is a common complication after severe TBI. Anticoagulant prophylaxis is often started late (≥3d) post-injury. Randomized trials are justifiable and necessary to provide practice guidance with regards to optimal timing of anticoagulant prophylaxis.

AB - Objectives: Venous thromboembolism (VTE) is a serious complication following severe traumatic brain injury (TBI), however, anticoagulant prophylaxis remains controversial due to concerns of intracranial hemorrhage (ICH) progression. We examined anticoagulant prophylaxis practice patterns at a major trauma centre and determined risk estimates for VTE and ICH progression classified by timing of anticoagulant initiation. Patients and methods: A 1-year prospective analysis of consecutive patients with severe TBI admitted to a Level-I trauma centre was conducted. In addition, we systematically reviewed the literature to identify studies on VTE and anticoagulant prophylaxis after severe TBI. Results: 64 severe TBI patients were included. 83% of patients received anticoagulant prophylaxis, initiated ≥3d post-TBI in 67%. The in-hospital VTE incidence was 16% and there was no significant difference between patients who received early (<3d) versus late (≥3d) prophylaxis (10% vs. 16%). Rates of ICH progression (0% vs. 7%) were similar between groups. Our systematic review identified 5 studies with VTE rates ranging from 5 to 10% with prophylaxis, to 11–30% without prophylaxis. The effect of timing of anticoagulant prophylaxis initiation on ICH progression was not reported in any study. Conclusion: VTE is a common complication after severe TBI. Anticoagulant prophylaxis is often started late (≥3d) post-injury. Randomized trials are justifiable and necessary to provide practice guidance with regards to optimal timing of anticoagulant prophylaxis.

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