Daley Mitchell J, Ali Sadia, Brown Carlos V R
Department of Pharmaceutical Services, University Medical Center Brackenridge, Austin, Texas, USA.
Am Surg. 2015 Feb;81(2):207-11.
The objective of this study is to compare rates of venous thromboembolism (VTE) in patients who receive enoxaparin prophylaxis compared with no enoxaparin prophylaxis after craniotomy for traumatic brain injury (TBI). This retrospective cohort evaluated all trauma patients admitted to a Level I trauma center from January 2006 to December 2011 who received craniotomy after acute TBI. Patients were excluded if developed VTE before administration of enoxaparin or they died within the first 72 hours of hospital admission. A total of 271 patients were included (enoxaparin prophylaxis, n = 45; no enoxaparin prophylaxis, n = 225). The median time until enoxaparin initiation was 11 ± 1 days. There was no significant difference in the proportion of patients who developed a VTE when using enoxaparin prophylaxis compared with no enoxaparin prophylaxis (2 vs 4%; P = 0.65). Rates of deep vein thrombosis (2 vs 3%; P = 0.87) and pulmonary embolism (0 vs 1%; P = 0.99) were similar between treatment groups, respectively. Late enoxaparin prophylaxis did not demonstrate a protective effect for VTE. Given the overall low event rate, the administration of pharmacologic prophylaxis against VTE late in the treatment course may not be routinely warranted after craniotomy for acute TBI. Further investigation with early administration of enoxaparin is needed.
本研究的目的是比较创伤性脑损伤（TBI）开颅术后接受依诺肝素预防与未接受依诺肝素预防的患者静脉血栓栓塞（VTE）发生率。这项回顾性队列研究评估了2006年1月至2011年12月入住一级创伤中心、急性TBI后接受开颅手术的所有创伤患者。如果患者在给予依诺肝素之前发生VTE或在入院后72小时内死亡，则将其排除。共纳入271例患者（依诺肝素预防组，n = 45；未接受依诺肝素预防组，n = 225）。开始使用依诺肝素的中位时间为11±1天。与未接受依诺肝素预防相比，接受依诺肝素预防的患者发生VTE的比例无显著差异（2%对4%；P = 0.65）。治疗组之间深静脉血栓形成率（2%对3%；P = 0.87）和肺栓塞率（0%对1%；P = 0.99）分别相似。晚期依诺肝素预防对VTE未显示出保护作用。鉴于总体事件发生率较低，急性TBI开颅术后在治疗过程后期常规给予VTE药物预防可能没有必要。需要对早期给予依诺肝素进行进一步研究。
