Atlantic Health System, Morristown Medical Center, Morristown, NJ, USA.
The Jewish Hospital-Mercy Health, Cincinnati, OH, USA.
J Pharm Pract. 2021 Dec;34(6):864-869. doi: 10.1177/0897190020929811. Epub 2020 Jun 8.
Traumatic brain injury (TBI) is an independent risk factor for venous thromboembolism (VTE). Prophylaxis (PPX) beyond 48 hours increases VTE risk 3- to 4-fold. Pharmacologic VTE PPX initiation is controversial due to potential bleeding complications.
To evaluate VTE PPX in patients with TBI for practice variation, efficacy, and safety.
Retrospective review from January 2013 to September 2016 in adults admitted to the intensive care unit with moderate to severe TBI. Demographics, time to stable computerized tomography scan, time to PPX initiation, PPX regimen, and incidences of VTE and adverse effects were collected. Data were analyzed via descriptive statistics, analysis of variance, and linear regression models.
Of 96 patients included, 14.6% did not receive VTE PPX (G1), 7.3% initiated therapy within 0 to 24 hours (G2), 14.6% after 24 to 48 hours (G3), and 63.5% after 48 hours (G4). VTE occurred in 0% of G1 and G2, 28.6% of G3, and 8.2% of G4 patients ( = .038). Of 9 VTE cases, 8 received medical and 1 received trauma PPX dosing ( = .44). There were 3 major bleeds ( = .79) and 19 minor bleeds ( = .042). Of 14 fatalities, 42.9% were in G1, 0% in G2, 14.2% in G3, and 42.9% in G4 ( = .009).
The majority of patients received delayed PPX, with no correlation between VTE incidence and PPX regimen. There was a significant difference in VTE incidence stratified by time to PPX. Further studies are required to determine optimal timing of PPX. Higher mortality rate was correlated with the lack of PPX. Increased minor bleeds occurred with earlier PPX initiation.
创伤性脑损伤（TBI）是静脉血栓栓塞症（VTE）的独立危险因素。超过 48 小时的预防（PPX）会使 VTE 的风险增加 3-4 倍。由于潜在的出血并发症，药物 VTE PPX 的启动存在争议。
评估 TBI 患者的 VTE PPX 以了解实践差异、疗效和安全性。
对 2013 年 1 月至 2016 年 9 月期间入住重症监护病房的中度至重度 TBI 成人患者进行回顾性研究。收集人口统计学资料、稳定的计算机断层扫描时间、PPX 开始时间、PPX 方案、VTE 发生率和不良反应。采用描述性统计、方差分析和线性回归模型进行数据分析。
在 96 例患者中，14.6%的患者未接受 VTE PPX（G1），7.3%在 0 至 24 小时内开始治疗（G2），14.6%在 24 至 48 小时内开始治疗（G3），63.5%在 48 小时后开始治疗（G4）。G1 和 G2 患者的 VTE 发生率为 0%，G3 患者为 28.6%，G4 患者为 8.2%（P =.038）。9 例 VTE 中有 8 例接受了医疗和 1 例创伤性 PPX 剂量（P =.44）。有 3 例大出血（P =.79）和 19 例小出血（P =.042）。14 例死亡患者中，42.9%在 G1，0%在 G2，14.2%在 G3，42.9%在 G4（P =.009）。
大多数患者接受了延迟的 PPX，VTE 发生率与 PPX 方案之间没有相关性。按 PPX 时间分层，VTE 发生率存在显著差异。需要进一步的研究来确定 PPX 的最佳时机。更高的死亡率与缺乏 PPX 有关。更早的 PPX 启动会导致更多的小出血。
