Prophylaxis for Venous Thromboembolism During Rehabilitation for Traumatic Brain Injury: A Multicenter Observational Study

Carlile, Mary C.; Nicewander, David; Yablon, Stuart A.; Brown, Allen W.; Brunner, Robert; Burke, David T.; Chae, Heechin; Englander, Jeffrey; Flanagan, S.; Khademi, Allen; Lombard, Lisa A.; Meythaler, Jay M.; Mysiw, W. Jerry; Zafonte, Ross

doi:10.1097/ta.0b013e3181b16d2d

Cited by 16 publications

(18 citation statements)

References 25 publications

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“…A majority of studies focused on the effects of PTP post TBI on VTE and/or hemorrhagic progression (n=21), and 2 RCTs evaluated coagulation parameters as the outcome. 38,39 Of those 21 studies on PTP, 7 had no control group, 13,14,40-44 6 studies compared PTP with no PTP, 8,12,45-48 3 studies compared enoxaparin to another anticoagulant agent, 10,49,50 and 5 studies evaluated the timing of prophylaxis. 11,51-54 On a scale of 27, only one out of the 23 studies scored >=20 and six scored >=18 on the Downs and Black checklist (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

“…45 The study sample consisted of 1,897 patients, 932 of whom received PTP and 965 did not. Incidence of symptomatic VTE was low in both the PTP and non-PTP groups (1.6% vs. 1.8%, respectively).…”

Section: Resultsmentioning

confidence: 99%

“…45 However, 5.5% of 1,075 patients screened positive for DVT at admission to rehabilitation, which suggests the potential value of PTP for TBI patients transitioning from hospitals to rehabilitation centers. There is insufficient evidence in the literature on the safety of resuming long-term anticoagulation after TBI or guidance in management of those patients taking oral anticoagulants before injury.…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of the Benefits and Risks of Anticoagulation Following Traumatic Brain Injury

Shen

Dutcher

Palmer

et al. 2015

Journal of Head Trauma Rehabilitation

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Objective The objective of the study was Tto synthesize the existing literature on benefits and risks of anticoagulant use after traumatic brain injury (TBI). Design: Systematic review A literature search was performed in Medline, IPA, Health Star and CINAHL on October 11, 2012 and updated on September 2, 2013, using terms related to TBI and anticoagulants. Main Measures Human studies evaluating the effects of post-TBI anticoagulation on venous thromboembolism (VTE), hemorrhage, mortality or coagulation parameters with original analyses were eligible for the review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed throughout the conduct of the review. Results Thirty-nine eligible studies were identified from the literature, of which 23 studies with complete information on post-TBI anticoagulant use and patient outcomes were summarized in this review. Meta-analysis was unwarranted due to varying methodological design and quality of the studies. Twenty-one studies focused on the effects of pharmacological thromboprophylaxis (PTP) post-TBI on VTE and/or progression of intracranial hemorrhage (ICH) while two RCTs analyzed coagulation parameters as the result of anticoagulation. Conclusion PTP appears to be safe among TBI patients with stabilized hemorrhagic patterns. More evidence is needed regarding effectiveness of PTP in preventing VTE as well as preferred agent, dose and timing for PTP.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of the Benefits and Risks of Anticoagulation Following Traumatic Brain Injury

Shen

Dutcher

Palmer

et al. 2015

Journal of Head Trauma Rehabilitation

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“…Prior studies examining anticoagulant therapy to reduce risk of VTE in patients with TBI have focused on the period immediately after injury and have not provided conclusive results regarding prevention of VTE or risk of hemorrhage. 7,11-13 Studies assessing the impact of early (≤72 hours post-TBI) vs late (>72 hours post-TBI) initiation of anticoagulation therapy on risk of VTE or hemorrhage have also reported conflicting results. 14,15 These studies were limited by small sample size, but more importantly, none focused on risk of stroke.…”

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confidence: 99%

Benefits and Risks of Anticoagulation Resumption Following Traumatic Brain Injury

et al. 2014

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“…Since 14E11 has been shown to be antithrombotic in rodent and primate models, 37,38 this is of particular importance regarding a second therapeutic approach: the safe prophylactic anticoagulation, which is required, for example, in patients who are immobilized in an intensive care unit; this is usually the case in the first days or weeks following TBI. 27,28 Until now, prophylactic anticoagulation in patients suffering from TBI remains a double edged sword 27,28,[61][62][63][64][65][66][67] : there is the risk of secondary thrombosis due to immobilization and altered coagulation after TBI versus the risk of exacerbating intracranial hemorrhage. After inhibiting FXI activation by FXIIa with 14E11 in our CCI model, we specifically determined intracranial hemorrhage and could not detect any detrimental effect 15 min or 24 h after trauma.…”

mentioning

confidence: 99%

The Formation of Microthrombi in Parenchymal Microvessels after Traumatic Brain Injury Is Independent of Coagulation Factor XI

Schwarzmaier

Chaumont

Balbi

et al. 2016

Journal of Neurotrauma

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Microthrombus formation and bleeding worsen the outcome after traumatic brain injury (TBI). The aim of the current study was to characterize these processes in the brain parenchyma after experimental TBI and to determine the involvement of coagulation factor XI (FXI). C57BL/6 mice (n = 101) and FXI-deficient mice (n = 15) were subjected to controlled cortical impact (CCI). Wild-type mice received an inhibitory antibody against FXI (14E11) or control immunoglobulin G 24 h before or 30 or 120 min after CCI. Cerebral microcirculation was visualized in vivo by 2-photon microscopy 2-3 h post-trauma and histopathological outcome was assessed after 24 h. TBI induced hemorrhage and microthrombus formation in the brain parenchyma ( p < 0.001). Inhibition of FXI activation or FXI deficiency did not reduce cerebral thrombogenesis, lesion volume, or hemispheric swelling. However, it also did not increase intracranial hemorrhage. Formation of microthrombosis in the brain parenchyma after TBI is independent of the intrinsic coagulation cascade since it was not reduced by inhibition of FXI. However, since targeting FXI has well-established antithrombotic effects in humans and experimental animals, inhibition of FXI could represent a reasonable strategy for the prevention of deep venous thrombosis in immobilized patients with TBI.

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Prophylaxis for Venous Thromboembolism During Rehabilitation for Traumatic Brain Injury: A Multicenter Observational Study

Cited by 16 publications

References 25 publications

A Systematic Review of the Benefits and Risks of Anticoagulation Following Traumatic Brain Injury

A Systematic Review of the Benefits and Risks of Anticoagulation Following Traumatic Brain Injury

Benefits and Risks of Anticoagulation Resumption Following Traumatic Brain Injury

The Formation of Microthrombi in Parenchymal Microvessels after Traumatic Brain Injury Is Independent of Coagulation Factor XI

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