Is low-molecular-weight heparin safe for venous thromboembolism prophylaxis in patients with traumatic brain injury? A Western Trauma Association multicenter study

Kwiatt, Michael; Patel, Mitul S.; Ross, Steven E.; Lachant, Mary T.; MacNew, Heather; Ochsner, M. Gage; Norwood, Scott H.; Speier, LaDonna; Kozar, Rosemary A.; Gerber, Jonathan A.; Rowell, Susan; Krishnakumar, Sheetal; Livingston, David H.; Manis, George; Haan, James M.

doi:10.1097/ta.0b013e318265cab9

Cited by 72 publications

(55 citation statements)

References 20 publications

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“…All the procedures were performed under general anesthesia, and vital signs (including pulse rate, temperature, respiration rate, and blood pressure) were continuously monitored throughout the procedure. Systemic heparinization (50–70 U/kg) with unfractionated heparin as a bolus followed by intermittent intravenous injections of 1000 U/h was routinely achieved before catheterization to maintain the activated clotting time at 250–300 s. Heparinization was reversed after the procedure owing to concerns about increasing the risk of IH 14 15. In addition, in our center, various embolization techniques such as the ‘jailing’ technique16 and the ‘stent-jack’ technique17 are performed in different situations at the discretion of the operators.…”

Section: Methodsmentioning

confidence: 99%

Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms

Liang

Wang

et al. 2015

J NeuroIntervent Surg

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Section: Methodsmentioning

confidence: 99%

Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms

Liang

Wang

et al. 2015

J NeuroIntervent Surg

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“…These results are consistent with other recent reports, which demonstrate safety and efficacy of chemoprophylaxis. 1,3,[5][6][7]10,12,[21][22][23] These studies vary in severity of head injury, time to initiation of chemoprophylaxis, chemoprophylaxis agent, and indications for postinitiation follow-up head CT to assess for hemorrhage progression. Most of these other studies focus on head AIS scores of 2 or 3 1,5,7,13,21,22 and range in initiation of chemoprophylaxis from 24 hours post injury up to 3 days after admission.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of early thromboembolism chemoprophylaxis after intracranial hemorrhage from traumatic brain injury

Farooqui

Hiser

Barnes

et al. 2013

JNS

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Object Patients with traumatic brain injury (TBI) are at risk for development of thromboembolic disease. The use of chemoprophylaxis in this patient group has not fully been characterized. The authors hypothesize that early chemoprophylaxis in patients with TBI is safe and efficacious. Methods In May 2009, a protocol was instituted for patients with TBI where chemoprophylaxis for thromboembolic disease (either 30 mg of Lovenox twice daily or 5000 U of heparin 3 times a day) was initiated 24 hours after an intracranial hemorrhage (ICH) was demonstrated as stable on head CT image. Two cohorts were evaluated: Cohort A included patients from May 2008 through April 2009 who had no routine administration of chemoprophylaxis, and Cohort B included patients from May 2009 through May 2010 after the protocol was instituted. The groups were compared, with the major outcomes being deep venous thrombosis (DVT), pulmonary embolism, and increase in size of ICH. Results Of the 312 patients with TBI who were seen during the study course, 236 patients met criteria for inclusion in the study: 107 patients in Cohort A and 129 patients in Cohort B. The DVT rate was 6 occurrences (5.61%) in Cohort A and 0 occurrences (0%) in Cohort B, which was a statistically significant difference (p = 0.0080). Pulmonary embolism was found in 4 patients (3.74%) in Cohort A and 1 patient (0.78%) in Cohort B, a difference that did not reach statistical significance (p = 0.18). Three instances (2.8%) in Cohort A and 1 instance (0.7%) in Cohort B of increased ICH occurred after starting anticoagulation for chemoprophylaxis; this was not statistically different (p = 0.33). Conclusions Use of chemoprophylaxis in TBI 24 hours after stable head CT is safe and decreases the rate of DVT formation.

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“…Several studies support the usage in the neurosurgical population as well [21][22][23][24]. The belief that pharmacologic VTE prophylaxis should be withheld in any patient at increased risk for bleeding is largely unsupported by literature, it is yet a practice widely performed.…”

Section: Scufh>24 H N=35 (P) Total Patients N=223mentioning

confidence: 99%

Bleeding Risk and Thromboprophylaxis in Neurosurgical Patients after Emergency Procedure

Cagliani¹,

Ritter²,

Nelson³

et al. 2017

Intensive & Crit Care

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Purpose: We aimed to evaluate its safety in the emergency neurosurgical population at a tertiary hospital center. Methods:Retrospective analyses of prospectively-collected data were performed on patients ad-mitted to the surgical intensive care unit (SICU) after emergency neurosurgical procedure. We examined patient demographic and clinical information, survival outcomes, and rates of heparin induced thrombocytopenia and pulmonary embolism in patients who received subcutaneous unfractionated heparin (SCUFH) compared to those who did not. Results: We identified 223 emergency neurosurgical patients, of which 100 received no anticoagulation (44.84%) and 123 received SCUFH (55.16%). In the SCUFH group, 88 patients received chemoprophylaxis within 24 h and 35 after 24 h. A statistically significant difference was noted with the admission APACHE II score of patients receiving SCUFH to those who did not, but APACHE III and SAPS on admission were shown to have no difference in outcome. Conclusion:Administration of SCUFH in the emergency neurosurgical population does not increase the risk of bleeding post-operatively and continues to be a safe and effective chemoprophylaxis agent against VTE.

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Is low-molecular-weight heparin safe for venous thromboembolism prophylaxis in patients with traumatic brain injury? A Western Trauma Association multicenter study

Abstract: Therapeutic study, level IV.

Cited by 72 publications

References 20 publications

Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms

Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms

Safety and efficacy of early thromboembolism chemoprophylaxis after intracranial hemorrhage from traumatic brain injury

Bleeding Risk and Thromboprophylaxis in Neurosurgical Patients after Emergency Procedure

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