Traumatic Brain Injury Is Associated With the Development of Deep Vein Thrombosis Independent of Pharmacological Prophylaxis

Autor: Nathan M. Bullington, Gerald McGwin, Loring W. Rue, Donald A. Reiff, Ramanath N. Haricharan, Russell Griffin
Rok vydání: 2009
Předmět:
Adult
Male
Traumatic brain injury
Injections
Subcutaneous
Deep vein
Critical Care and Intensive Care Medicine
Risk Assessment
Sensitivity and Specificity
Drug Administration Schedule
Cohort Studies
Age Distribution
Injury Severity Score
Trauma Centers
Reference Values
Confidence Intervals
medicine
Humans
Glasgow Coma Scale
Hospital Mortality
cardiovascular diseases
Enoxaparin
Sex Distribution
Risk factor
Probability
Retrospective Studies
Venous Thrombosis
Analysis of Variance
Chi-Square Distribution
Dose-Response Relationship
Drug
Heparin
Vascular disease
business.industry
Incidence
Anticoagulants
Retrospective cohort study
medicine.disease
Survival Analysis
Thrombosis
Primary Prevention
Venous thrombosis
Treatment Outcome
medicine.anatomical_structure
Brain Injuries
Anesthesia
Female
Surgery
business
Follow-Up Studies
Zdroj: Journal of Trauma: Injury, Infection & Critical Care. 66:1436-1440
ISSN: 0022-5282
Popis: Deep venous thrombosis (DVT) is common among trauma patients. If left untreated it may result in lethal pulmonary thromboembolism. Previous studies have suggested that intracranial hemorrhage serves as an independent risk factor for the development of DVT. These studies were not able to exclude anticoagulation therapy as a confounding variable in their analysis. Our objective was to determine the association of traumatic brain injury (TBI) to the formation of DVT irrespective of the use of anticoagulation therapy.All patients admitted to an academic level I Trauma Center between 2000 and 2007 with blunt or penetrating injuries were selected for inclusion in this study. Patients who died or who were discharged within 24 hours of admission were excluded in the analysis. TBI was defined as any intraparenchymal hemorrhage or extra-axial intracranial bleeding identified on radiographic imaging or both. Anticoagulation therapy was defined as the uninterrupted use of either subcutaneous lovenox or heparin. Risk ratios and 95% confidence intervals compared the risk of DVT among patients with and without TBI according to the initiation of anticoagulation therapy (no therapy,24 hours, 24-48 hours, and48 hours) adjusted for age, gender, race, injury severity, mechanism of injury, spinal injury, and lower extremity fracture.Irrespective of the time of initiation of pharmacologic prophylaxis, TBI is independently associated with the formation of DVT. A threefold to fourfold increased risk of DVT formation is consistent across all prophylaxis groups among patients with TBI.The incidence of DVT among injured patients with TBI is significantly higher than those patients without head injury independent of anticoagulation therapy. Rigorous surveillance to detect DVT among trauma patients with TBI should be undertaken and where appropriate alternate means for pulmonary thromboembolism prevention used.
Databáze: OpenAIRE
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