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Intensive Care Med. 2017 Mar;43(3):419-428. doi: 10.1007/s00134-016-4655-2. Epub 2016 Dec 27.

Venous thromboembolic events in critically ill traumatic brain injury patients.

Author information

1
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia. markus.skrifvars@monash.edu.
2
Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland. markus.skrifvars@monash.edu.
3
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
4
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
5
Department of Intensive Care, Western Health, Melbourne, VIC, Australia.
6
University of Melbourne, Melbourne, VIC, Australia.
7
School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
8
Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
9
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Assistance Publique des Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Paris, France.
10
Department of Anaesthesiology and Intensive Care Medicine, CHRU La Cavale Blanche, Université de Bretagne Occidentale, Brest, France.
11
King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
12
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
13
Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.

Abstract

PURPOSE:

To estimate the prevalence, risk factors, prophylactic treatment and impact on mortality for venous thromboembolism (VTE) in patients with moderate to severe traumatic brain injury (TBI) treated in the intensive care unit.

METHODS:

A post hoc analysis of the erythropoietin in traumatic brain injury (EPO-TBI) trial that included twice-weekly lower limb ultrasound screening. Venous thrombotic events were defined as ultrasound-proven proximal deep venous thrombosis (DVT) or clinically detected pulmonary embolism (PE). Results are reported as events, percentages or medians and interquartile range (IQR). Cox regression analysis was used to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI) for time to VTE and death.

RESULTS:

Of 603 patients, 119 (19.7%) developed VTE, mostly comprising DVT (102 patients, 16.9%) with a smaller number of PE events (24 patients, 4.0%). Median time to DVT diagnosis was 6 days (IQR 2-11) and to PE diagnosis 6.5 days (IQR 2-16.5). Mechanical prophylaxis (MP) was used in 91% of patients on day 1, 97% of patients on day 3 and 98% of patients on day 7. Pharmacological prophylaxis was given in 5% of patients on day 1, 30% of patients on day 3 and 57% of patients on day 7. Factors associated with time to VTE were age (HR per year 1.02, 95% CI 1.01-1.03), patient weight (HR per kg 1.01, 95% CI 1-1.02) and TBI severity according to the International Mission for Prognosis and Analysis of Clinical Trials risk of poor outcome (HR per 10% increase 1.12, 95% CI 1.01-1.25). The development of VTE was not associated with mortality (HR 0.92, 95% CI 0.51-1.65).

CONCLUSIONS:

Despite mechanical and pharmacological prophylaxis, VTE occurs in one out of every five patients with TBI treated in the ICU. Higher age, greater weight and greater severity of TBI increase the risk. The development of VTE was not associated with excess mortality.

KEYWORDS:

Deep venous thrombosis; Erythropoietin; Pulmonary embolism; Traumatic brain injury; Venous thromboembolism

PMID:
28028552
DOI:
10.1007/s00134-016-4655-2
[Indexed for MEDLINE]

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