Pharmacologic Thromboprophylaxis Is a Risk Factor for Hemorrhage Progression in a Subset of Patients With Traumatic Brain Injury

被引:55
作者
Levy, Andrew Stewart
Salottolo, Kristin [1 ,2 ]
Bar-Or, Raphael [1 ,2 ]
Offner, Patrick [2 ,3 ]
Mains, Charles [2 ,3 ,4 ]
Sullivan, Michael [1 ,2 ]
Bar-Or, David [1 ,2 ,4 ]
机构
[1] Swedish Med Ctr, Trauma Res Dept, Englewood, CO 80113 USA
[2] St Anthony Cent Hosp, Trauma Res Dept, Denver, CO USA
[3] St Anthony Cent Hosp, Trauma Serv Dept, Denver, CO USA
[4] Rocky Vista Univ, Aurora, CO USA
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2010年 / 68卷 / 04期
关键词
Prophylaxis; Traumatic brain injury; Thromboembolism; Lovenox; Intracranial hemorrhage; VENOUS THROMBOEMBOLISM PROPHYLAXIS; MOLECULAR-WEIGHT HEPARIN; HEAD COMPUTED-TOMOGRAPHY; NONOPERATIVE MANAGEMENT; ENOXAPARIN PROPHYLAXIS; 1602; EPISODES; DATA-BANK; SAFETY; PATTERNS; FAILURE;
D O I
10.1097/TA.0b013e3181d27dd5
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Pharmacologic thromboprophylaxis (PTP) may exacerbate intracranial hemorrhage (ICH) in patients with traumatic brain injury (TBI). We examined risk factors for hemorrhage progression in patients with blunt TBI and hypothesized that PTP would increase ICH progression in a subset of these patients. Methods: We retrospectively studied patients with TBI admitted to our level I trauma center during 19 months. Progression of hemorrhage was examined in two populations: patients with a stable initial follow-up (F/U) computed tomography (CT) and patients with hemorrhage progression on initial F/U CT. Risk factors potentially associated with hemorrhage progression were analyzed using logistic regression. Timing of PTP was defined two ways: exposed to PTP versus not exposed; early (<72 hours), late (>= 72 hours), or no PTP. Results: Three hundred forty patients with TBI were reviewed and hemorrhage progression occurred in 32.4% (n = 110) of patients of which 59.1% were considered clinically significant. In patients with ICH progression on initial F/U CT, predictors of subsequent hemorrhage progression include exposure to PTP (odds ratio [OR]: 13.07, p = 0.01), extradural/subdural hemorrhage (OR: 5.15, p = 0.03), Glasgow Coma Score 3-8 (OR: 4.64, p = 0.03), and body mass index >= 25 (OR = 4.32, p = 0.03). PTP was not significantly associated with hemorrhage progression in patients with a stable initial F/U CT. Conclusions: These findings suggest that PTP use is associated with a 13-fold increased odds of further hemorrhage progression in patients whose F/U CT within 1 day of admission showed ICH progression; 16% of this risk can be attributed to receiving PTP. Conversely, PTP may be safe in a subgroup of patients with TBI with no ICH progression on initial F/U CT.
引用
收藏
页码:886 / 892
页数:7
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