Highlights
- •Among TBI patients, pharmacologic immobilization correlated with a higher VTE rate.
- •Time to VTE from the date of trauma can manifest over weeks and may be occult.
- •Uncontrolled ICPs can complicate timely surgical stabilization and anticoagulation.
Abstract
Traumatic brain injury (TBI) patients are known to have a high rate of venous thromboembolism
(VTE), and additional neuromuscular blockade or barbiturate coma therapy has the theoretical
risk of exacerbating baseline hemostasis and elevating the incidence of thromboembolic
events. We conducted a single-institution retrospective review of patients surviving
severe TBI, as determined by need for intracranial pressure (ICP) monitoring, who
further required paralytics or barbiturate therapy to maintain ICP control. Patients
were administered VTE prophylaxis as clinically appropriate. Predictors for VTE were
subsequently determined with univariate and logistic multivariate regression analyses.
The main cohort includes 144 patients, 34 of whom received pharmaceutical immobilization
for ICP control. Mean ISS and GCS at intake were 31.9 and 5.2, respectively. Among
those receiving vs not-receiving paralytics and/or barbiturate therapy, there was
a statistical difference of 12/34 (35.3%) vs 18/110 (16.4%, p = 0.0280) in VTE events,
at a mean time greater than two weeks from the time of trauma. Multivariate logistics
regression indicated 3.2 times increased odds of developing a VTE (log odds = 1.17,
p = 0.023). No pediatric patients were positive for an event (0/12 vs 7/22, p = 0.0356),
and infections were only documented among those with VTE (0/22 vs 4/12, p = 0.0107).
Overall, paralytics and barbiturate therapy were correlated with a higher incidence
of VTE among TBI patients. Although the need for ICP control will outweigh an increase
in thromboembolic risk, there is value for increased surveillance and screening during
the prolonged inpatient stay of these patients.
Keywords
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Article info
Publication history
Published online: March 31, 2020
Accepted:
March 20,
2020
Received:
January 17,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
