From the Division of Trauma and Acute Care Surgery, Department of Surgery (P.J.S., S.S., D.B., S.H., M.M., A.E.), Kendall Regional Medical Center, Miami; and University of South Florida (D.B., M.M.), Tampa, Florida.
J Trauma Acute Care Surg. 2020 Mar;88(3):454-460. doi: 10.1097/TA.0000000000002580.
Traumatic brain injury (TBI) continues to be a deadly injury. Universally accepted guidelines regarding the use of venous thromboembolism (VTE) chemoprophylaxis in trauma patients presenting with TBI have not been established. The purpose of this review was to identify and review the current literature and present the evidence for anticoagulant chemoprophylaxis regimens in patients with TBI.
A search of five databases including PubMed, Web of Science, Google Scholar, JAMA Network, and Cochrane Journals was conducted for studies evaluating the safety and efficacy of venous thromboembolism prophylaxis regimens according to the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria were used for quality of evidence assessment.
Seventeen studies were included in this review: 1 randomized controlled trial, 2 prospective observational studies, 10 retrospective reviews, and 5 systematic reviews. Most studies demonstrated that early chemoprophylactic administration is associated with a decreased incidence of VTE in patients with TBI without an increase in intracranial bleed.
For patients with TBI resulting in intracranial hemorrhages, administration of VTE chemoprophylaxis is warranted for those patients with stable repeat computed tomography scans. Early chemoprophylaxis, at 24 to 72 hours is associated with reduced VTE incidence without a corresponding increase or exacerbation of intracranial hemorrhage in patients with TBI who have a stable repeat head computed tomography scan. More studies are needed to establish guidelines for the safety and efficacy of VTE prophylaxis protocols in adult patients with TBI.
Systematic review, level III.
颅脑创伤（TBI）仍然是一种致命的损伤。目前尚未制定出针对 TBI 患者使用静脉血栓栓塞症（VTE）化学预防的普遍接受的指南。本综述的目的是确定和回顾当前的文献，并提出 TBI 患者抗凝化学预防方案的证据。
对包括 PubMed、Web of Science、Google Scholar、JAMA Network 和 Cochrane Journals 在内的五个数据库进行了搜索，以寻找评估 VTE 预防方案的安全性和有效性的研究，这些研究符合系统评价和荟萃分析报告的首选项目指南。使用推荐评估、制定和评估（GRADE）工作组标准评估证据质量。
本综述纳入了 17 项研究：1 项随机对照试验、2 项前瞻性观察性研究、10 项回顾性研究和 5 项系统评价。大多数研究表明，早期化学预防与 TBI 患者 VTE 发生率降低相关，而颅内出血无增加。
对于导致颅内出血的 TBI 患者，对于那些颅内重复 CT 扫描稳定的患者，需要使用 VTE 化学预防。在颅内重复 CT 扫描稳定的 TBI 患者中，早期（24 至 72 小时）化学预防与 VTE 发生率降低相关，而颅内出血无相应增加或加重。需要更多的研究来确定成人 TBI 患者 VTE 预防方案的安全性和有效性指南。
系统评价，III 级。
