Journal article
Early VTE prophylaxis in severe traumatic brain injury: A propensity score weighted EAST multicenter study
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, v 95(1), p94
Jul 2023
PMID: 37017458
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND: Patients with traumatic brain injury (TBI) are at high risk of venous thromboembolism events (VTE). We hypothesized that early chemical VTE prophylaxis initiation (<= 24 hours of a stable head CT) in severe TBI would reduce VTE without increasing risk of intracranial hemorrhage expansion (ICHE). METHODS: A retrospective reviewof adult patients 18 years or older with isolated severe TBI (Abbreviated Injury Scale score, >= 3) who were admitted to 24 Level I and Level II trauma centers from January 1, 2014 to December 31 2020 was conducted. Patients were divided into those who did not receive any VTE prophylaxis (NO VTEP), who received VTE prophylaxis <= 24 hours after stable head CT (VTEP <= 24) and who received VTE prophylaxis >24 hours after stable head CT (VTEP>24). Primary outcomes were VTE and ICHE. Covariate balancing propensity score weighting was utilized to balance demographic and clinical characteristics across three groups. Weighted univariate logistic regression models were estimated for VTE and ICHE with patient group as predictor of interest. RESULTS: Of 3,936 patients, 1,784 met inclusion criteria. Incidences of VTE was significantly higher in the VTEP>24 group, with higher incidences of DVT in the group. Higher incidences of ICHE were observed in the VTEP <= 24 and VTEP>24 groups. After propensity score weighting, there was a higher risk of VTE in patients in VTEP >24 compared with those in VTEP <= 24 (odds ratio, 1.51; 95% confidence interval, 0.69-3.30; p = 0.307), however was not significant. Although, the No VTEP group had decreased odds of having ICHE compared with VTEP <= 24 (odds ratio, 0.75; 95% confidence interval, 0.55-1.02, p = 0.070), the result was not statistically significant. CONCLUSION: In this large multi-center analysis, there were no significant differences in VTE based on timing of initiation of VTE prophylaxis. Patients who never received VTE prophylaxis had decreased odds of ICHE. Further evaluation of VTE prophylaxis in larger randomized studies will be necessary for definitive conclusions.
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Details
- Title
- Early VTE prophylaxis in severe traumatic brain injury: A propensity score weighted EAST multicenter study
- Publication Details
- JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, v 95(1), p94
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:001020223600015
- Scopus ID
- 2-s2.0-85163855395
- Other Identifier
- 991021861200504721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Critical Care Medicine
- Surgery