Rivas Lisbi, Vella Michael, Ju Tammy, Fernandez-Moure Joseph S, Sparks Andrew, Seamon Mark J, Sarani Babak
Center for Trauma and Critical Care, Department of Surgery, 50430George Washington University, Washington, DC, USA.
Department of Surgery, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Am Surg. 2022 Feb;88(2):187-193. doi: 10.1177/0003134820983171. Epub 2021 Jan 27.
Timing to start of chemoprophylaxis for venous thromboembolism (VTE) in patients with traumatic brain injury (TBI) remains controversial. We hypothesize that early administration is not associated with increased intracranial hemorrhage.
A retrospective study of adult patients with TBI following blunt injury was performed. Patients with penetrating brain injury, any moderate/severe organ injury other than the brain, need for craniotomy/craniectomy, death within 24 hours of admission, or progression of bleed on 6 hour follow-up head computed tomography scan were excluded. Patients were divided into early (≤24 hours) and late (>24 hours) cohorts based on time to initiation of chemoprophylaxis. Progression of bleed was the primary outcome.
264 patients were enrolled, 40% of whom were in the early cohort. The average time to VTE prophylaxis initiation was 17 hours and 47 hours in the early and late groups, respectively ( < .0001). There was no difference in progression of bleed (5.6% vs. 7%, = .67), craniectomy/-craniotomy rate (1.9% vs. 2.5%, = .81), or VTE rate (0% vs. 2.5%, = .1).
Early chemoprophylaxis is not associated with progression of hemorrhage or need for neurosurgical intervention in patients with TBI and a stable head CT 7 hours following injury.
创伤性脑损伤（TBI）患者开始静脉血栓栓塞（VTE）化学预防的时机仍存在争议。我们假设早期给药与颅内出血增加无关。
对钝性损伤后成年TBI患者进行回顾性研究。排除穿透性脑损伤患者、除脑以外的任何中度/重度器官损伤患者、需要开颅手术/颅骨切除术的患者、入院24小时内死亡的患者或伤后6小时头颅计算机断层扫描显示出血进展的患者。根据开始化学预防的时间，将患者分为早期（≤24小时）和晚期（>24小时）队列。出血进展是主要结局。
共纳入264例患者，其中40%在早期队列。早期和晚期组开始VTE预防的平均时间分别为17小时和47小时（P<0.0001）。出血进展（5.6%对7%，P=0.67）、颅骨切除术/开颅手术率（1.9%对2.5%，P=0.81）或VTE发生率（0%对2.5%，P=0.1）无差异。
对于伤后7小时头颅CT稳定的TBI患者，早期化学预防与出血进展或神经外科干预需求无关。
