Rhodes-Lyons Heather X, Elkbuli Adel, Kumar Sanjan, Espat Nikita Nunes, Johnson Sarah E, McClure David L, Pepe Antonio
Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, WI, 54449, USA.
Department of Surgery, Division of Trauma and Surgical Critical Care, Department of Surgical Education, Orlando Regional Medical Center, 52 W Underwood St, Orlando, FL, 32806, USA.
Neurocrit Care. 2025 May 21. doi: 10.1007/s12028-025-02283-4.
There is little research on venous thromboembolism (VTE) prophylaxis (PPX) timing of the higher rebleeding risk groups based on size and type of traumatic brain injury (TBI) due to exclusion from previous observational studies, which prohibits the facilitation of an evidence-based strategy. We aim to determine the effect of VTE PPX timing on the high rebleeding risk TBI population based on the modified Berne Norwood Criteria.
This retrospective cohort study used the American College of Surgeons Trauma Quality Program Participant Use File from 2017 to 2022. The study population consisted of adult patients who received chemical or mechanical PPX with no missing times and had a blunt high rebleeding risk TBI stratified by a comorbid history of anticoagulation or bleeding disorder with excluded polytrauma. There was a total of 12 exposure groups based on VTE PPX timing with the outcomes of interest being intensive care unit (ICU) stay, ventilation days, and mortality.
A total of 13,016 patients were included in the exploratory analysis. Early initiation of chemical VTE PPX (within ≤ 24 h) was associated with a reduced likelihood of prolonged ICU stay and ventilation days, regardless of prior anticoagulation use or bleeding disorder. In contrast, inferior vena cava filter placement within the > 24-h to < 72-h window was associated with increased ICU and ventilation duration.
This study highlights the benefits of initiating chemical VTE PPX within 24 h for patients wih high rebleeding risk TBI, demonstrating significant reductions in ICU stays and ventilation days without an increase in mortality rates. Additionally, although inferior vena cava filters are associated with longer ICU stays and increased ventilation days, this may reflect the greater severity and potential mortality risk of the conditions being treated.
由于先前的观察性研究将其排除在外，因此关于基于创伤性脑损伤（TBI）的大小和类型的高再出血风险组的静脉血栓栓塞症（VTE）预防（PPX）时机的研究很少，这阻碍了循证策略的实施。我们旨在根据改良的伯尔尼诺伍德标准确定VTE PPX时机对高再出血风险TBI人群的影响。
这项回顾性队列研究使用了2017年至2022年美国外科医师学会创伤质量项目参与者使用文件。研究人群包括接受化学或机械PPX且无时间缺失的成年患者，这些患者因抗凝或出血性疾病合并症而有钝性高再出血风险TBI，且排除多发伤。基于VTE PPX时机共有12个暴露组，感兴趣的结局为重症监护病房（ICU）住院时间、通气天数和死亡率。
共有13016名患者纳入探索性分析。化学性VTE PPX早期启动（≤24小时内）与缩短ICU住院时间和通气天数的可能性降低相关，无论先前是否使用抗凝剂或存在出血性疾病。相比之下，在>24小时至<72小时窗口内放置下腔静脉滤器与ICU和通气持续时间增加相关。
本研究强调了在24小时内启动化学性VTE PPX对高再出血风险TBI患者的益处，表明ICU住院时间和通气天数显著减少，且死亡率没有增加。此外，尽管下腔静脉滤器与更长的ICU住院时间和增加的通气天数相关，但这可能反映了所治疗疾病的更严重程度和潜在死亡风险。
