Does traumatic brain injury increase the risk for venous thromboembolism in polytrauma patients?

Evan J. Valle, Robert M. Van Haren, Casey J. Allen, Jassin M. Jouria, Ross Bullock, Carl I Schulman, Nicholas Namias, Alan Livingstone, Kenneth G Proctor

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

BACKGROUND: Trauma is a major risk factor for venous thromboembolism (VTE). Traumatic brain injury (TBI) is generally considered to further increase the VTE risk, which should prompt routine thromboprophylaxis. However, the associated risk for intracranial hemorrhage often delays anticoagulants. We test the hypothesis that TBI associated with polytrauma results in a higher rate of VTE than polytrauma without TBI. METHODS: From August 2011 to June 2013, a prospective observational trial with informed consent was performed in 148 intensive care unit (ICU) patients with a Greenfield Risk Assessment Profile score of 10 or greater. RESULTS: Demographics, Greenfield Risk Assessment Profile scores, the incidence of polytrauma, and mortality were similar, but TBI patients had worse Injury Severity Scores (ISS) (32 vs. 22), longer ICU lengths of stay (21 days vs. 12 days), more hypercoagulable thromboelastogram values on admission (94% vs. 79%), more received unfractionated heparin prophylaxis (65% vs. 36%), and the prophylaxis start date was more than a day later (all p < 0.05). Nevertheless, the VTE rate with TBI was similar to that without TBI (25% vs. 26%, p = 0.507). Furthermore, VTE occurred at similar time points after ICU admission with and without TBI. In both groups, about 30% of the VTEs were detected within 2 days of ICU admission and 50% of the VTEs occurred within 10 days of admission despite chemical and mechanical thromboprophylaxis. CONCLUSION: In complex polytrauma patients who survived to ICU admission and who were prescreened for high VTE risk, TBI did not further increase the risk for VTE. The most likely explanation is that no single risk factor is necessary or sufficient for VTE development, especially in those who routinely receive chemical and mechanical thromboprophylaxis. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Original languageEnglish
Pages (from-to)243-250
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number2
DOIs
StatePublished - Jan 1 2014

Fingerprint

Multiple Trauma
Venous Thromboembolism
Intensive Care Units
Injury Severity Score
Traumatic Brain Injury
Intracranial Hemorrhages
Informed Consent
Anticoagulants
Heparin
Epidemiologic Studies
Length of Stay
Demography
Mortality
Incidence
Wounds and Injuries

Keywords

  • Coagulopathy
  • Heparin
  • Intensive care unit
  • Thromboelastography

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Does traumatic brain injury increase the risk for venous thromboembolism in polytrauma patients? / Valle, Evan J.; Van Haren, Robert M.; Allen, Casey J.; Jouria, Jassin M.; Bullock, Ross; Schulman, Carl I; Namias, Nicholas; Livingstone, Alan; Proctor, Kenneth G.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 2, 01.01.2014, p. 243-250.

Research output: Contribution to journalArticle

@article{fdf534186fc14966a2e17e721d42ed1d,
title = "Does traumatic brain injury increase the risk for venous thromboembolism in polytrauma patients?",
abstract = "BACKGROUND: Trauma is a major risk factor for venous thromboembolism (VTE). Traumatic brain injury (TBI) is generally considered to further increase the VTE risk, which should prompt routine thromboprophylaxis. However, the associated risk for intracranial hemorrhage often delays anticoagulants. We test the hypothesis that TBI associated with polytrauma results in a higher rate of VTE than polytrauma without TBI. METHODS: From August 2011 to June 2013, a prospective observational trial with informed consent was performed in 148 intensive care unit (ICU) patients with a Greenfield Risk Assessment Profile score of 10 or greater. RESULTS: Demographics, Greenfield Risk Assessment Profile scores, the incidence of polytrauma, and mortality were similar, but TBI patients had worse Injury Severity Scores (ISS) (32 vs. 22), longer ICU lengths of stay (21 days vs. 12 days), more hypercoagulable thromboelastogram values on admission (94{\%} vs. 79{\%}), more received unfractionated heparin prophylaxis (65{\%} vs. 36{\%}), and the prophylaxis start date was more than a day later (all p < 0.05). Nevertheless, the VTE rate with TBI was similar to that without TBI (25{\%} vs. 26{\%}, p = 0.507). Furthermore, VTE occurred at similar time points after ICU admission with and without TBI. In both groups, about 30{\%} of the VTEs were detected within 2 days of ICU admission and 50{\%} of the VTEs occurred within 10 days of admission despite chemical and mechanical thromboprophylaxis. CONCLUSION: In complex polytrauma patients who survived to ICU admission and who were prescreened for high VTE risk, TBI did not further increase the risk for VTE. The most likely explanation is that no single risk factor is necessary or sufficient for VTE development, especially in those who routinely receive chemical and mechanical thromboprophylaxis. LEVEL OF EVIDENCE: Epidemiologic study, level III.",
keywords = "Coagulopathy, Heparin, Intensive care unit, Thromboelastography",
author = "Valle, {Evan J.} and {Van Haren}, {Robert M.} and Allen, {Casey J.} and Jouria, {Jassin M.} and Ross Bullock and Schulman, {Carl I} and Nicholas Namias and Alan Livingstone and Proctor, {Kenneth G}",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/TA.0000000000000307",
language = "English",
volume = "77",
pages = "243--250",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Does traumatic brain injury increase the risk for venous thromboembolism in polytrauma patients?

AU - Valle, Evan J.

AU - Van Haren, Robert M.

AU - Allen, Casey J.

AU - Jouria, Jassin M.

AU - Bullock, Ross

AU - Schulman, Carl I

AU - Namias, Nicholas

AU - Livingstone, Alan

AU - Proctor, Kenneth G

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND: Trauma is a major risk factor for venous thromboembolism (VTE). Traumatic brain injury (TBI) is generally considered to further increase the VTE risk, which should prompt routine thromboprophylaxis. However, the associated risk for intracranial hemorrhage often delays anticoagulants. We test the hypothesis that TBI associated with polytrauma results in a higher rate of VTE than polytrauma without TBI. METHODS: From August 2011 to June 2013, a prospective observational trial with informed consent was performed in 148 intensive care unit (ICU) patients with a Greenfield Risk Assessment Profile score of 10 or greater. RESULTS: Demographics, Greenfield Risk Assessment Profile scores, the incidence of polytrauma, and mortality were similar, but TBI patients had worse Injury Severity Scores (ISS) (32 vs. 22), longer ICU lengths of stay (21 days vs. 12 days), more hypercoagulable thromboelastogram values on admission (94% vs. 79%), more received unfractionated heparin prophylaxis (65% vs. 36%), and the prophylaxis start date was more than a day later (all p < 0.05). Nevertheless, the VTE rate with TBI was similar to that without TBI (25% vs. 26%, p = 0.507). Furthermore, VTE occurred at similar time points after ICU admission with and without TBI. In both groups, about 30% of the VTEs were detected within 2 days of ICU admission and 50% of the VTEs occurred within 10 days of admission despite chemical and mechanical thromboprophylaxis. CONCLUSION: In complex polytrauma patients who survived to ICU admission and who were prescreened for high VTE risk, TBI did not further increase the risk for VTE. The most likely explanation is that no single risk factor is necessary or sufficient for VTE development, especially in those who routinely receive chemical and mechanical thromboprophylaxis. LEVEL OF EVIDENCE: Epidemiologic study, level III.

AB - BACKGROUND: Trauma is a major risk factor for venous thromboembolism (VTE). Traumatic brain injury (TBI) is generally considered to further increase the VTE risk, which should prompt routine thromboprophylaxis. However, the associated risk for intracranial hemorrhage often delays anticoagulants. We test the hypothesis that TBI associated with polytrauma results in a higher rate of VTE than polytrauma without TBI. METHODS: From August 2011 to June 2013, a prospective observational trial with informed consent was performed in 148 intensive care unit (ICU) patients with a Greenfield Risk Assessment Profile score of 10 or greater. RESULTS: Demographics, Greenfield Risk Assessment Profile scores, the incidence of polytrauma, and mortality were similar, but TBI patients had worse Injury Severity Scores (ISS) (32 vs. 22), longer ICU lengths of stay (21 days vs. 12 days), more hypercoagulable thromboelastogram values on admission (94% vs. 79%), more received unfractionated heparin prophylaxis (65% vs. 36%), and the prophylaxis start date was more than a day later (all p < 0.05). Nevertheless, the VTE rate with TBI was similar to that without TBI (25% vs. 26%, p = 0.507). Furthermore, VTE occurred at similar time points after ICU admission with and without TBI. In both groups, about 30% of the VTEs were detected within 2 days of ICU admission and 50% of the VTEs occurred within 10 days of admission despite chemical and mechanical thromboprophylaxis. CONCLUSION: In complex polytrauma patients who survived to ICU admission and who were prescreened for high VTE risk, TBI did not further increase the risk for VTE. The most likely explanation is that no single risk factor is necessary or sufficient for VTE development, especially in those who routinely receive chemical and mechanical thromboprophylaxis. LEVEL OF EVIDENCE: Epidemiologic study, level III.

KW - Coagulopathy

KW - Heparin

KW - Intensive care unit

KW - Thromboelastography

UR - http://www.scopus.com/inward/record.url?scp=84905028267&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905028267&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000000307

DO - 10.1097/TA.0000000000000307

M3 - Article

C2 - 25058249

AN - SCOPUS:84905028267

VL - 77

SP - 243

EP - 250

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2

ER -