Therapeutic anticoagulation in patients with traumatic brain injury
| Autor: | Demetrios Demetriades, Gabriel Zada, Jayun Cho, Stefan W. Leichtle, Kenji Inaba, Keith D. Herr, Hussan Mohammed, Kazuhide Matsushima |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Traumatic brain injury chemical and pharmacologic phenomena 03 medical and health sciences 0302 clinical medicine Brain Injuries Traumatic medicine Humans Prospective cohort study Aged Retrospective Studies Aged 80 and over business.industry Incidence (epidemiology) Brain Hemorrhage Traumatic Glasgow Coma Scale Anticoagulants 030208 emergency & critical care medicine Retrospective cohort study Atrial fibrillation Odds ratio Venous Thromboembolism Middle Aged medicine.disease stomatognathic diseases Anesthesia Disease Progression Injury Severity Score Surgery Female business 030217 neurology & neurosurgery |
| Zdroj: | The Journal of surgical research. 205(1) |
| ISSN: | 1095-8673 |
| Popis: | Background Therapeutic anticoagulation (TAC) is often required in trauma patients for various indications. However, it remains unknown whether TAC can be safely initiated in the postinjury period for patients with traumatic brain injury (TBI). The purpose of this study was to evaluate the safety of TAC in TBI patients. Materials and methods We conducted a 7-y retrospective study. All TBI patients who received TAC within 60 d postinjury were included. In addition to patient and injury characteristics, detailed information regarding TAC was collected. The primary outcome was the incidence of neurologic deterioration or progression of hemorrhagic TBI on repeat head computed tomography (CT) after initiation of TAC. Univariate and multivariate analyses were used to identify factors associated with progression of hemorrhagic TBI after TAC. Results A total of 3355 TBI patients were identified. Of those, 72 patients (2.1%) received TAC. Median age, 59; 76.4% male; median Injury Severity Score, 19; median admission Glasgow Coma Scale, 14; and median Rotterdam score on the initial head CT, 3. Although atrial fibrillation was the most common preinjury indication for TAC, venous thromboembolism was the most common postinjury indication. The median postinjury time of initiation of TAC was 9 d. Intravenous heparin infusion was the most commonly used agent for TAC (70.8%). None of our study patients developed any signs of neurologic deterioration due to TAC. Progression of hemorrhagic TBI on repeat head CT was observed in six patients. In a multiple logistic regression model, aged ≥65 y was significantly associated with progression of hemorrhagic TBI after TAC (odds ratio, 15.2; 95% confidence interval, 1.1-212.7; P = 0.04). Conclusions This study shows preliminary data regarding TAC initiated in patients with TBI. Further prospective study is warranted to determine the risks and benefits of TAC in this specific group of patients. |
| Databáze: | OpenAIRE |
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