TY - JOUR
T1 - Early VTE prophylaxis in severe traumatic brain injury
T2 - A propensity score weighted EAST multicenter study
AU - Ratnasekera, Asanthi M.
AU - Kim, Daniel
AU - Seng, Sirivan S.
AU - Jacovides, Christina
AU - Kaufman, Elinore J.
AU - Sadek, Hannah M.
AU - Perea, Lindsey L.
AU - Monaco, Christina
AU - Shnaydman, Ilya
AU - Lee, Alexandra Jeongyoon
AU - Sharp, Victoria
AU - Miciura, Angela
AU - Trevizo, Eric
AU - Rosenthal, Martin
AU - Lottenberg, Lawrence
AU - Zhao, William
AU - Keininger, Alicia
AU - Hunt, Michele
AU - Cull, John
AU - Balentine, Chassidy
AU - Egodage, Tanya
AU - Mohamed, Aleem
AU - Kincaid, Michelle
AU - Doris, Stephanie
AU - Cotterman, Robert
AU - Seegert, Sara
AU - Jacobson, Lewis E.
AU - Williams, Jamie
AU - Whitmill, Melissa
AU - Palmer, Brandi
AU - Mentzer, Caleb
AU - Tackett, Nichole
AU - Hranjec, Tjasa
AU - Dougherty, Thomas
AU - Morrissey, Shawna
AU - Donatelli-Seyler, Lauren
AU - Rushing, Amy
AU - Tatebe, Leah C.
AU - Nevill, Tiffany J.
AU - Aboutanos, Michel B.
AU - Hamilton, David
AU - Redmond, Diane
AU - Cullinane, Daniel C.
AU - Falank, Carolyne
AU - Mcmellen, Mark
AU - Duran, Christ
AU - Daniels, Jennifer
AU - Ballow, Shana
AU - Schuster, Kevin
AU - Ferrada, Paula
N1 - Funding Information:
We are grateful to our colleagues from EAST TBI VTE research group for their contribution to the study. Without their work this article would not have been possible. Center for Biostatistics and Health Data Science: Alexandra Hanlon PhD, Danielle Sienko MS, Wenyan Ji MA, Alicia Lozano MS. Crozer Health: Sandra Durgin MSN RN CEN, Alexander Papa DO, Danielle Lapoint DO, Ammar Humayun MD; Loma Linda University: Georgi Mladenov MD, Xian Luo-Owen PhD, St. Mary's Medical Center: Alyha Benitez, John Sousa MD, Sarah Lee MD, Matthew Zinner MD; Promedica Toledo Hospital: Diane Philip MSN, RN, Tyler Wilbarger RN; Spartanburg Medical Center: Thomas J. Mack. University Hospitals Cleveland Medical Center: Angelica Bartholomew RN, Murathan Kahyaoglu. Research reported in this publication was supported by Eastern Association for the Surgery of Trauma, Junior Multicenter Investigator Award 2022. DISCLOSURE
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - BACKGROUND Patients with traumatic brain injury (TBI) are at high risk of venous thromboembolism events (VTE). We hypothesized that early chemical VTE prophylaxis initiation (≤24 hours of a stable head CT) in severe TBI would reduce VTE without increasing risk of intracranial hemorrhage expansion (ICHE). METHODS A retrospective review of adult patients 18 years or older with isolated severe TBI (Abbreviated Injury Scale score, ≥ 3) who were admitted to 24 Level I and Level II trauma centers from January 1, 2014 to December 31 2020 was conducted. Patients were divided into those who did not receive any VTE prophylaxis (NO VTEP), who received VTE prophylaxis ≤24 hours after stable head CT (VTEP ≤24) and who received VTE prophylaxis >24 hours after stable head CT (VTEP>24). Primary outcomes were VTE and ICHE. Covariate balancing propensity score weighting was utilized to balance demographic and clinical characteristics across three groups. Weighted univariate logistic regression models were estimated for VTE and ICHE with patient group as predictor of interest. RESULTS Of 3,936 patients, 1,784 met inclusion criteria. Incidences of VTE was significantly higher in the VTEP>24 group, with higher incidences of DVT in the group. Higher incidences of ICHE were observed in the VTEP≤24 and VTEP>24 groups. After propensity score weighting, there was a higher risk of VTE in patients in VTEP >24 compared with those in VTEP≤24 (odds ratio, 1.51; 95% confidence interval, 0.69-3.30; p = 0.307), however was not significant. Although, the No VTEP group had decreased odds of having ICHE compared with VTEP≤24 (odds ratio, 0.75; 95% confidence interval, 0.55-1.02, p = 0.070), the result was not statistically significant. CONCLUSION In this large multi-center analysis, there were no significant differences in VTE based on timing of initiation of VTE prophylaxis. Patients who never received VTE prophylaxis had decreased odds of ICHE. Further evaluation of VTE prophylaxis in larger randomized studies will be necessary for definitive conclusions. LEVEL OF EVIDENCE Therapeutic Care Management; Level III.
AB - BACKGROUND Patients with traumatic brain injury (TBI) are at high risk of venous thromboembolism events (VTE). We hypothesized that early chemical VTE prophylaxis initiation (≤24 hours of a stable head CT) in severe TBI would reduce VTE without increasing risk of intracranial hemorrhage expansion (ICHE). METHODS A retrospective review of adult patients 18 years or older with isolated severe TBI (Abbreviated Injury Scale score, ≥ 3) who were admitted to 24 Level I and Level II trauma centers from January 1, 2014 to December 31 2020 was conducted. Patients were divided into those who did not receive any VTE prophylaxis (NO VTEP), who received VTE prophylaxis ≤24 hours after stable head CT (VTEP ≤24) and who received VTE prophylaxis >24 hours after stable head CT (VTEP>24). Primary outcomes were VTE and ICHE. Covariate balancing propensity score weighting was utilized to balance demographic and clinical characteristics across three groups. Weighted univariate logistic regression models were estimated for VTE and ICHE with patient group as predictor of interest. RESULTS Of 3,936 patients, 1,784 met inclusion criteria. Incidences of VTE was significantly higher in the VTEP>24 group, with higher incidences of DVT in the group. Higher incidences of ICHE were observed in the VTEP≤24 and VTEP>24 groups. After propensity score weighting, there was a higher risk of VTE in patients in VTEP >24 compared with those in VTEP≤24 (odds ratio, 1.51; 95% confidence interval, 0.69-3.30; p = 0.307), however was not significant. Although, the No VTEP group had decreased odds of having ICHE compared with VTEP≤24 (odds ratio, 0.75; 95% confidence interval, 0.55-1.02, p = 0.070), the result was not statistically significant. CONCLUSION In this large multi-center analysis, there were no significant differences in VTE based on timing of initiation of VTE prophylaxis. Patients who never received VTE prophylaxis had decreased odds of ICHE. Further evaluation of VTE prophylaxis in larger randomized studies will be necessary for definitive conclusions. LEVEL OF EVIDENCE Therapeutic Care Management; Level III.
KW - intracranial hemorrhage expansion
KW - TBI
KW - VTE
KW - VTE prophylaxis
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U2 - 10.1097/TA.0000000000003985
DO - 10.1097/TA.0000000000003985
M3 - Article
C2 - 37017458
AN - SCOPUS:85163855395
SN - 2163-0755
VL - 95
SP - 94
EP - 104
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -