Risk of Venous Thromboembolism in Patients with Large Hemispheric Infarction Undergoing Decompressive Hemicraniectomy

Chalouhi, Nohra; Daou, Badih; Rincón, Fred; Montaño, M.J. Gordillo; Kent, Anthony P.; Barkley, Kaitlyn; Starke, Robert M.; Tjoumakaris, Stavropoula; Hasan, David; Dalyai, Richard; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1007/s12028-016-0252-z

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…9,10,37 By contrast, DVT rates exceeding 30% have been reported with routine screening Doppler ultrasonography after moderate-to-severe traumatic brain injury (without chemoprophylaxis) 13 or large hemispheric infarction requiring decompressive hemicraniectomy (with chemoprophylaxis). 38 We found no association between VTE and age, gender, or any particular diagnostic group. Compared to the previous studies of medical–surgical critically ill patients reporting VTE rates of 2% to 10%, 2 –5 the frequency of VTE in neurocritical care patients appears to be on the lower side; a higher incidence of VTE in sepsis and septic shock patients might explain this finding.…”

Section: Discussioncontrasting

confidence: 54%

“…57 High BMI has been reported to be an independent risk factor for thromboprophylaxis failure in critically ill patients and has been associated with VTE in patients with subarachnoid hemorrhage and large hemispheric infarction undergoing decompressive hemicraniectomy in previous studies. 5,9,38,39,58 Higher weight-based doses of anticoagulant prophylaxis have been reported to maintain peak plasma anti-Xa levels within or near the recommended range for thromboprophylaxis and to reduce in-hospital VTE in morbidly obese patients without increasing the risk of bleeding. [59][60][61][62] Further study is required to determine the efficacy and safety of weight-based chemoprophylaxis in obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…The median time to VTE diagnosis has varied from 6 to 18 days in previous studies of neurological patients. 14,37,38 Based on these data, screening compression ultrasonography at about 1 week is reasonable and might be beneficial, particularly in high-risk patients who are obese, older than 60 years, immobilized, have central venous access, or have a history of cancer, thrombophilia, or prior VTE.…”

Section: Discussionmentioning

confidence: 99%

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Venous Thromboembolism in Neurocritical Care Patients

Viarasilpa

Panyavachiraporn

Jordan

et al. 2019

J Intensive Care Med

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Background: Venous thromboembolism (VTE) is a potentially life-threatening complication among critically ill patients. Neurocritical care patients are presumed to be at high risk for VTE; however, data regarding risk factors in this population are limited. We designed this study to evaluate the frequency, risk factors, and clinical impact of VTE in neurocritical care patients. Methods: We obtained data from the electronic medical record of all adult patients admitted to neurological intensive care unit (NICU) at Henry Ford Hospital between January 2015 and March 2018. Venous thromboembolism was defined as deep vein thrombosis, pulmonary embolism, or both diagnosed by Doppler, chest computed tomography (CT) angiography or ventilation–perfusion scan >24 hours after admission. Patients with ICU length of stay <24 hours or who received therapeutic anticoagulants or were diagnosed with VTE within 24 hours of admission were excluded. Results: Among 2188 consecutive NICU patients, 63 (2.9%) developed VTE. Prophylactic anticoagulant use was similar in patients with and without VTE (95% vs 92%; P = .482). Venous thromboembolism was associated with higher mortality (24% vs 13%, P = .019), and longer ICU (12 [interquartile range, IQR 5-23] vs 3 [IQR 2-8] days, P < .001) and hospital (22 [IQR 15-36] vs 8 [IQR 5-15] days, P < .001) length of stay. In a multivariable analysis, potentially modifiable predictors of VTE included central venous catheterization (odds ratio [OR] 3.01; 95% confidence interval [CI], 1.69-5.38; P < .001) and longer duration of immobilization (Braden activity score <3, OR 1.07 per day; 95% CI, 1.05-1.09; P < .001). Nonmodifiable predictors included higher International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) scores (which accounts for age >60, prior VTE, cancer and thrombophilia; OR 1.66; 95% CI, 1.40-1.97; P < .001) and body mass index (OR 1.05; 95% CI, 1.01-1.08; P = .007). Conclusions: Despite chemoprophylaxis, VTE still occurred in 2.9% of neurocritical care patients. Longer duration of immobilization and central venous catheterization are potentially modifiable risk factors for VTE in critically ill neurological patients.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Venous Thromboembolism in Neurocritical Care Patients

Viarasilpa

Panyavachiraporn

Jordan

et al. 2019

J Intensive Care Med

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“…Several previous studies have focused on one single medical complication and its management in DHC cohorts, with little discussion of neurological complications. [23][24][25][26][27] Moreover, there are few data available to indicate the impact of different stroke-related complications on unfavorable outcome in patients with LHI. In our cohort, we found that LHI patients with unfavorable outcomes had more frequent stroke-related complications than those with favorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome

Zhang

et al. 2019

Ther Adv Neurol Disord

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Objective: Neurological and medical complications are major causes of morbidity and mortality after ischemic stroke. This study aimed to identify the incidence of stroke-related complications following large hemisphere infarction (LHI) and to explore their influence on unfavorable outcome in LHI patients. Methods: We prospectively enrolled consecutive patients with LHI. The unfavorable outcome was defined as an modified Rankin Scale (mRS) score of 4–6 at 3 months. Multivariate logistic regression analysis was employed to identify the stroke-related complications associated with unfavorable outcome. Results: Of the 256 cases with LHI included, 41 (16.0%) died during hospitalization, 94 (36.7%) died and 140 (55.3%) patients had unfavorable outcome at 3 months. A total of 194 (75.8%) had at least one complication. The three most common medical complications were pneumonia (53.5%), electrolyte disorder (30.9%), and urinary incontinence (18.4%), and the three most common neurological complications were malignant brain edema (31.2%), hemorrhagic transformation (27.7%), and poststroke seizures (7.0%). Overall, LHI patients with unfavorable outcome had more frequent stroke-related complications (91.4% versus 55.8%, p < 0.001) than patients with favorable outcome. After adjusting for age, baseline National Institutes of Health Stroke Scale score, and other confounders, only malignant brain edema [odds ratios (OR) 19.76, 95% confidence interval (CI) 4.73–82.45] and pneumonia (OR 2.45, 95% CI 1.11–5.40) were independently associated with 3-month unfavorable outcome in patients with LHI. Conclusions: More than three-quarters of LHI patients have at least one stroke-related complication. LHI patients with the unfavorable outcome had stroke-related complications more frequently, whereas only malignant brain edema and pneumonia are independently associated with 3-month unfavorable outcome.

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