A Potentially Expanded Role for Enoxaparin in Preventing Venous Thromboembolism in High Risk Blunt Trauma Patients

Norwood, Scott H.; McAuley, Clyde E.; Berne, John D.; Vallina, Van L.; Kerns, D.Brent; Grahm, Thomas W.; McLarty, Jerry

doi:10.1016/s1072-7515(00)00802-4

Cited by 78 publications

(43 citation statements)

References 28 publications

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“…The VTE protocol that was in force throughout the study required that enoxaparin administration be withheld for 72 hours in patients with nonoperatively treated splenic injuries. This portion of the VTE protocol was initiated based on our limited experience with splenic-injured patients from our first study 8 of enoxaparin for prophylaxis. In this study, we observed a 17% incidence of significant delayed bleeding in nonoperatively treated patients with splenic injuries when enoxaparin was administered within the first 24 hours of hospital admission.…”

Section: Commentmentioning

confidence: 99%

“…The existing randomized studies 5,6 in trauma patients examining the efficacy of the low-molecular-weight heparin enoxaparin sodium for preventing VTE excluded patients with head injuries. However, a recent prospective, single-cohort study 8 examining the use of enoxaparin in preventing VTE in high-risk blunt trauma patients included a subgroup of 55 patients with blunt IHIs. This study 8 reported no bleeding complications in the subgroup of head-injured patients, suggesting that administration of enoxaparin might be a beneficial method for VTE prophylaxis in patients with IHIs.…”

mentioning

confidence: 99%

“…Based on the low incidence of deep vein thrombosis (DVT) in our first study, 8 we no longer routinely evaluate asymptomatic patients for DVT during hospitalization or before hospital discharge if enoxaparin is used for DVT prophylaxis. High-risk patients who cannot receive enoxaparin are screened with Doppler examination before hospital discharge.…”

mentioning

confidence: 99%

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Prospective Evaluation of the Safety of Enoxaparin Prophylaxis for Venous Thromboembolism in Patients With Intracranial Hemorrhagic Injuries

Norwood

McAuley²,

Berne³

et al. 2002

Arch Surg

141

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Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

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Prospective Evaluation of the Safety of Enoxaparin Prophylaxis for Venous Thromboembolism in Patients With Intracranial Hemorrhagic Injuries

Norwood

McAuley²,

Berne³

et al. 2002

Arch Surg

141

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“…[9][10][11][12][13][14][15][16][17][18] An exception to this general rule was the work of Berne and Norwood, who had promulgated a set of intracranial injury patterns that could safely receive enoxaparin 30 mg subcutaneously beginning 24 h after injury if a repeat CT scan of the head was stable. [6][7][8] Using their work as a starting point, our group modified these criteria and created the Parkland Protocol. This original version of the protocol …”

Section: Discussionmentioning

confidence: 99%

The Parkland Protocol's Modified Berne-Norwood Criteria Predict Two Tiers of Risk for Traumatic Brain Injury Progression

Pastorek

Cripps

Bernstein

et al. 2014

Journal of Neurotrauma

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As a basis for venous thromboembolism (VTE) prophylaxis after traumatic brain injury (TBI), we have previously published an algorithm known as the Parkland Protocol. Patients are classified by risk for spontaneous progression of hemorrhage with chemoprophylaxis regimens tailored to each tier. We sought to validate this schema. In our algorithm, patients with any of the following are classified ''low risk'' for spontaneous progression: subdural hemorrhage £ 8 mm thick; epidural hemorrhage £ 8 mm thick; contusions £ 20 mm in diameter; a single contusion per lobe; any amount of subarachnoid hemorrhage; or any amount of intraventricular hemorrhage. Patients with any injury exceeding these are ''moderate risk'' for progression, and any patient receiving a monitor or craniotomy is ''high risk.'' From February 2010 to November 2012, TBI patients were entered into a dedicated database tracking injury types and sizes, risk category at presentation, and progression on subsequent computed tomgraphies (CTs). The cohort (n = 414) was classified as low risk (n = 200), moderate risk (n = 75), or high risk (n = 139) after first CT. After repeat CT scan, radiographic progression was noted in 27% of low-risk, 53% of moderate-risk, and 58% of high-risk subjects. Omnibus analysis of variance test for differences in progression rates was highly significant ( p < 0.0001). Tukey's post-hoc test showed the low-risk progression rate to be significantly different than both the moderate-and high-risk arms; no difference was noted between the moderate-and high-risk arms themselves. These criteria are a valid tool for classifying TBI patients into two categories of risk for spontaneous progression. This supports tailored chemoprophylaxis regimens for each arm.

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“…Some studies have demonstrated an increased rate of intracranial hemorrhage when VTE chemoprophylaxis is initiated preoperatively [45]. Other studies have demonstrated no statistically significant association between the two [75][76][77][78].…”

Section: Prophylaxis Chemicalmentioning

confidence: 99%

Venous Thromboembolism in Brain Tumor Patients: A Review of Literature

Coté¹,

Smith

2015

J Hematol Thrombo Dis

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Venous thromboembolism (VTE) is a relatively common and well-described condition, affecting approximately 1-2% of the general population. VTE can lead to significant morbidity and death via pulmonary embolism (PE). During the post-operative period, VTE occurs at higher rates due to natural thrombotic responses to injury and limited post-operative mobility. In general, rates of post-operative VTE are higher in patients undergoing operations for cranial and spinal lesions than for lesions of other types, a phenomenon that is not fully explained. Several studies have demonstrated that other risk factors for VTE include age, sex, ethnicity, hospital stay length, and coagulation state. Aggressive chemical and mechanical measures for VTE prophylaxis are indicated in the postoperative period to prevent the formation of VTE. Here we review the literature on VTE in brain tumor patients, with a focus on their etiology, diagnosis, treatment, and prophylaxis.

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A Potentially Expanded Role for Enoxaparin in Preventing Venous Thromboembolism in High Risk Blunt Trauma Patients

Cited by 78 publications

References 28 publications

Prospective Evaluation of the Safety of Enoxaparin Prophylaxis for Venous Thromboembolism in Patients With Intracranial Hemorrhagic Injuries

Prospective Evaluation of the Safety of Enoxaparin Prophylaxis for Venous Thromboembolism in Patients With Intracranial Hemorrhagic Injuries

The Parkland Protocol's Modified Berne-Norwood Criteria Predict Two Tiers of Risk for Traumatic Brain Injury Progression

Venous Thromboembolism in Brain Tumor Patients: A Review of Literature

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