Elevated risk of venous thromboembolism among post-traumatic brain injury patients requiring pharmaceutical immobilization. (May 2020)

• Record Type: Journal Article
• Authors: Zhang, Michael; Parikh, Bhavya; Dirlikov, Ben; Cage, Tene; Lee, Marco; Singh, Harminder
• Is Part Of: Journal of clinical neuroscience. Volume 75(2020)
• Page Start: 66
• Page End: 70
• Publication Date: 2020-05
• Subjects: Barbiturates -- Deep venous thrombosis -- Intracranial pressure -- Neuromuscular blockade -- Traumatic brain injury -- Pulmonary embolism -- Venous thromboembolism; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.03.028
• Languages: English
• ISSNs: 0967-5868

Abstract

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.