University Hospital of Zurich, Zurich, Switzerland.
Unit of Clinical Epidemiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Anaesthesiol Intensive Ther. 2020;52(1):28-33. doi: 10.5114/ait.2020.93395.
Venous thromboembolism (VTE) is a recognized complication in patients with traumatic brain injury (TBI) and is associated with increased morbidity and mortality. Currently, no standard exists for optimal timing or a pharmacological agent for VTE prophylaxis (pharmacological thromboprophylaxis - PTP) in patients with TBI. PTP is often delayed out of fear of causing extension of intracranial hemorrhage (ICH). The purpose of this study was to report the frequency of VTE and ICH progression after initiation of PTP with a continuous infusion of unfractionated heparin in patients with moderate to severe TBI, and to identify risk factors associated with development of VTE.
In this single-center retrospective study, patients with moderate to severe TBI admitted to the ICU of a Swiss Level I Trauma Center over a three-year period were analyzed.
In 23 (13%) of the 177 patients included in the study a VTE episode occurred during the hospital stay. ICH progression after initiation of PTP occurred in 7 (4%) patients. In a multivariable logistic regression model, only the timing of initiation of PTP was identified as an independent predictor of VTE.
In this study population, the risk of developing VTE increased with the delay of initiation of a pharmacological VTE prophylaxis, while ICH progression after initiation of PTP was a rare event.
静脉血栓栓塞症（VTE）是颅脑创伤（TBI）患者的一种公认并发症，与发病率和死亡率增加有关。目前，TBI 患者中 VTE 预防（药物性血栓预防-PTP）的最佳时机或药物尚无标准。出于担心导致颅内出血（ICH）扩展的原因，PTP 常被延迟。本研究的目的是报告在中度至重度 TBI 患者中使用未分级肝素连续输注开始 PTP 后 VTE 和 ICH 进展的频率，并确定与 VTE 发展相关的危险因素。
在这项单中心回顾性研究中，分析了在瑞士一级创伤中心 ICU 住院的 3 年期间中度至重度 TBI 患者。
在纳入研究的 177 名患者中，23 名（13%）发生了 VTE 发作。在开始 PTP 后发生 ICH 进展的患者有 7 名（4%）。在多变量逻辑回归模型中，只有 PTP 开始的时机被确定为 VTE 的独立预测因子。
在本研究人群中，随着药物性 VTE 预防开始的延迟，发生 VTE 的风险增加，而在开始 PTP 后 ICH 进展是一种罕见事件。
