Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe - University Frankfurt am Main, Frankfurt/Main, Germany.
Brain Inj. 2022 Jul 3;36(8):1046-1052. doi: 10.1080/02699052.2022.2105951. Epub 2022 Aug 3.
Venous thromboembolism (VTE) in severely injured patients with severe traumatic brain injury (TBI) is a risk during the clinical course. Data on the safety of an early initiation of pharmacological VTE prophylaxis in severely injured patients with concomitant severe TBI is sparse.
Admissions to our level-1-trauma center between January 2015 and December 2018 were screened. Patients suffering from severe TBI (Abbreviated Injury Scale (AIS) of the head ≥3) and at least one further AIS ≥ 3 in any other body region were included. Demographic data, thromboembolic events, and progression of the intracranial hemorrhage were extracted from the patient's charts. According to the first application of pharmacological thromboprophylaxis (VTEp), patients were categorized either to the early, the late (later than 24 h) or the no therapy group.
In 79 patients (early: n = 35, late: n = 29, no therapy: n = 15) the Injury Severity Score (ISS) was 36.7 ± 12.7 points (AIS 4.1 ± 0.8). No differences were found regarding the progression of the intracranial hemorrhage after initiation of the VTE prophylaxis (adj. p = 0.8). The VTE rate was low (n = 1, 1.6%).
In severely injured patients with severe TBI, the early administration of pharmacological thromboprophylaxis did not result in a higher rate of intracranial hematoma progression.
严重创伤性脑损伤（TBI）合并严重损伤的患者在临床过程中存在静脉血栓栓塞（VTE）风险。关于在严重损伤合并严重 TBI 的患者中早期开始药物性 VTE 预防的安全性的数据很少。
筛选了 2015 年 1 月至 2018 年 12 月期间我院 1 级创伤中心的入院患者。纳入标准为患有严重 TBI（头部损伤严重程度评分（AIS）≥3）和至少一个其他身体部位的 AIS≥3。从患者病历中提取人口统计学数据、血栓栓塞事件和颅内出血进展情况。根据药物性血栓预防（VTEp）的首次应用，将患者分为早期、晚期（晚于 24 小时）或无治疗组。
79 例患者（早期：n=35，晚期：n=29，无治疗：n=15）的损伤严重程度评分（ISS）为 36.7±12.7 分（AIS 4.1±0.8）。在开始 VTE 预防后，颅内出血进展方面没有差异（调整后 p=0.8）。VTE 发生率较低（n=1，1.6%）。
在严重损伤合并严重 TBI 的患者中，早期给予药物性血栓预防并未导致颅内血肿进展率增加。
