Department of Neurosurgery, New York University School of Medicine, New York, New York.
Department of Neurology, New York University School of Medicine, New York, New York.
Neurosurgery. 2017 Dec 1;81(6):1016-1020. doi: 10.1093/neuros/nyx164.
Venous thromboembolism is a common complication of traumatic brain injury with an estimated incidence of 25% when chemoprophylaxis is delayed. The timing of initiating prophylaxis is controversial given the concern for hemorrhage expansion.
To determine the safety of initiating venous thromboembolic event (VTE) chemoprophylaxis within 24 h of presentation.
We performed a retrospective analysis of patients with traumatic intracranial hemorrhage presenting to a level I trauma center. Patients receiving early chemoprophylaxis (<24 h) were compared to the matched cohort of patients who received heparin in a delayed fashion (>48 h). The primary outcome of the study was radiographic expansion of the intracranial hemorrhage. Secondary outcomes included VTE, use of intracranial pressure (ICP) monitoring, delayed decompressive surgery, and all-cause mortality.
Of 282 patients, 94 (33%) received chemoprophylaxis within 24 h of admission. The cohorts were evenly matched across all variables. The primary outcome occurred in 18% of patients in the early cohort compared to 17% in the delayed cohort (P = .83). Fifteen patients (16%) in the early cohort underwent an invasive procedure in a delayed fashion; this compares to 35 patients (19%) in the delayed cohort (P = .38). Five patients (1.7%) in our study had a VTE during their hospitalization; 2 of these patients received early chemoprophylaxis (P = .75). The rate of mortality from all causes was similar in both groups.
Early (<24 h) initiation of VTE chemoprophylaxis in patients with traumatic intracranial hemorrhage appears to be safe. Further prospective studies are needed to validate this finding.
静脉血栓栓塞是创伤性脑损伤的常见并发症，当化学预防延迟时，估计发病率为 25%。由于担心出血扩大，启动预防的时间存在争议。
确定在出现后 24 小时内开始静脉血栓栓塞事件（VTE）化学预防的安全性。
我们对就诊于一级创伤中心的创伤性颅内出血患者进行了回顾性分析。接受早期化学预防（<24 小时）的患者与接受肝素延迟（>48 小时）的患者进行了匹配队列比较。该研究的主要结果是颅内血肿的影像学扩大。次要结果包括 VTE、颅内压（ICP）监测的使用、延迟减压手术和全因死亡率。
在 282 名患者中，94 名（33%）在入院后 24 小时内接受了化学预防。两组在所有变量上均匹配。早期组的主要结局发生率为 18%，而延迟组为 17%（P=.83）。15 名（16%）早期组患者在延迟时接受了侵入性手术；而延迟组有 35 名（19%）患者（P=.38）。在我们的研究中，有 5 名患者（1.7%）在住院期间发生 VTE；其中 2 名患者接受了早期化学预防（P=.75）。两组的全因死亡率相似。
在创伤性颅内出血患者中，早期（<24 小时）开始 VTE 化学预防似乎是安全的。需要进一步的前瞻性研究来验证这一发现。
