Prophylaxis for venous thromboembolism during rehabilitation for traumatic brain injury: A multicenter observational study

Mary Carlile, David Nicewander, Stuart A. Yablon, Allen W Brown, Robert Brunner, David Burke, Heechin Chae, Jeffrey Englander, Steve Flanagan, Flora Hammond, Allen Khademi, Lisa A. Lombard, Jay M. Meythaler, W. Jerry Mysiw, Ross Zafonte, Ramon Diaz-Arrastia

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Deep venous thrombosis (DVT) is a major cause of mortality and morbidity after traumatic brain injury (TBI). There is no consensus regarding appropriate screening, prophylaxis, or treatment during acute rehabilitation. METHODS:: This prospective observational study evaluated prophylactic anticoagulation during rehabilitation in patients with TBI aged 16 years or older admitted to 12 TBI Model Systems rehabilitation centers (July 2004-December 2007). After propensity score stratification within center, the odds ratio associated with incidence of symptomatic DVT or pulmonary embolism (PE) for patients who did and did not receive prophylactic anticoagulation was estimated using conditional logistic regression in patients who were not screened for DVT on rehabilitation admission or who screened negative; the analysis was repeated in these two subgroups. RESULTS:: Patients with identified DVTs at rehabilitation admission (n = 266) were excluded, leaving 1,897 patients: 1,002 screened negative, 895 unscreened; 932 received prophylactic anticoagulation, and 965 did not. Symptomatic DVT/PE was detected in 32 patients (15 of 932 [1.6%] with prophylaxis, 17 of 965 [1.8%] without). After propensity score adjustment, the odds ratio (95% confidence interval) for symptomatic DVT/PE with prophylaxis versus no prophylaxis was 0.80 (0.33-1.94) in the full analytic population and 0.46 (0.12-1.84) in the screened-negative subgroup. The only probable venous thromboembolism-related death occurred in the prophylactic anticoagulation group. Fewer new/expanded intracranial hemorrhages occurred among patients who received prophylactic anticoagulation. CONCLUSIONS:: Prophylactic anticoagulation during rehabilitation seemed safe for TBI patients whose physicians deemed it appropriate, but did not conclusively reduce venous thromboembolism. Given the number of DVTs present before rehabilitation, screening and prophylaxis during acute care may be more important.

Original languageEnglish (US)
Pages (from-to)916-923
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume68
Issue number4
DOIs
StatePublished - Apr 2010

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Venous Thromboembolism
Multicenter Studies
Observational Studies
Rehabilitation
Venous Thrombosis
Pulmonary Embolism
Propensity Score
Odds Ratio
Rehabilitation Centers
Traumatic Brain Injury
Intracranial Hemorrhages
Logistic Models
Prospective Studies
Confidence Intervals
Morbidity
Physicians
Mortality
Incidence
Population

Keywords

  • Prophylactic anticoagulation
  • Traumatic brain injury
  • Venous thromboembolism

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Prophylaxis for venous thromboembolism during rehabilitation for traumatic brain injury : A multicenter observational study. / Carlile, Mary; Nicewander, David; Yablon, Stuart A.; Brown, Allen W; Brunner, Robert; Burke, David; Chae, Heechin; Englander, Jeffrey; Flanagan, Steve; Hammond, Flora; Khademi, Allen; Lombard, Lisa A.; Meythaler, Jay M.; Mysiw, W. Jerry; Zafonte, Ross; Diaz-Arrastia, Ramon.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 68, No. 4, 04.2010, p. 916-923.

Research output: Contribution to journalArticle

Carlile, M, Nicewander, D, Yablon, SA, Brown, AW, Brunner, R, Burke, D, Chae, H, Englander, J, Flanagan, S, Hammond, F, Khademi, A, Lombard, LA, Meythaler, JM, Mysiw, WJ, Zafonte, R & Diaz-Arrastia, R 2010, 'Prophylaxis for venous thromboembolism during rehabilitation for traumatic brain injury: A multicenter observational study', Journal of Trauma - Injury, Infection and Critical Care, vol. 68, no. 4, pp. 916-923. https://doi.org/10.1097/TA.0b013e3181b16d2d
Carlile, Mary ; Nicewander, David ; Yablon, Stuart A. ; Brown, Allen W ; Brunner, Robert ; Burke, David ; Chae, Heechin ; Englander, Jeffrey ; Flanagan, Steve ; Hammond, Flora ; Khademi, Allen ; Lombard, Lisa A. ; Meythaler, Jay M. ; Mysiw, W. Jerry ; Zafonte, Ross ; Diaz-Arrastia, Ramon. / Prophylaxis for venous thromboembolism during rehabilitation for traumatic brain injury : A multicenter observational study. In: Journal of Trauma - Injury, Infection and Critical Care. 2010 ; Vol. 68, No. 4. pp. 916-923.
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abstract = "BACKGROUND: Deep venous thrombosis (DVT) is a major cause of mortality and morbidity after traumatic brain injury (TBI). There is no consensus regarding appropriate screening, prophylaxis, or treatment during acute rehabilitation. METHODS:: This prospective observational study evaluated prophylactic anticoagulation during rehabilitation in patients with TBI aged 16 years or older admitted to 12 TBI Model Systems rehabilitation centers (July 2004-December 2007). After propensity score stratification within center, the odds ratio associated with incidence of symptomatic DVT or pulmonary embolism (PE) for patients who did and did not receive prophylactic anticoagulation was estimated using conditional logistic regression in patients who were not screened for DVT on rehabilitation admission or who screened negative; the analysis was repeated in these two subgroups. RESULTS:: Patients with identified DVTs at rehabilitation admission (n = 266) were excluded, leaving 1,897 patients: 1,002 screened negative, 895 unscreened; 932 received prophylactic anticoagulation, and 965 did not. Symptomatic DVT/PE was detected in 32 patients (15 of 932 [1.6{\%}] with prophylaxis, 17 of 965 [1.8{\%}] without). After propensity score adjustment, the odds ratio (95{\%} confidence interval) for symptomatic DVT/PE with prophylaxis versus no prophylaxis was 0.80 (0.33-1.94) in the full analytic population and 0.46 (0.12-1.84) in the screened-negative subgroup. The only probable venous thromboembolism-related death occurred in the prophylactic anticoagulation group. Fewer new/expanded intracranial hemorrhages occurred among patients who received prophylactic anticoagulation. CONCLUSIONS:: Prophylactic anticoagulation during rehabilitation seemed safe for TBI patients whose physicians deemed it appropriate, but did not conclusively reduce venous thromboembolism. Given the number of DVTs present before rehabilitation, screening and prophylaxis during acute care may be more important.",
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AU - Nicewander, David

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AU - Brown, Allen W

AU - Brunner, Robert

AU - Burke, David

AU - Chae, Heechin

AU - Englander, Jeffrey

AU - Flanagan, Steve

AU - Hammond, Flora

AU - Khademi, Allen

AU - Lombard, Lisa A.

AU - Meythaler, Jay M.

AU - Mysiw, W. Jerry

AU - Zafonte, Ross

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N2 - BACKGROUND: Deep venous thrombosis (DVT) is a major cause of mortality and morbidity after traumatic brain injury (TBI). There is no consensus regarding appropriate screening, prophylaxis, or treatment during acute rehabilitation. METHODS:: This prospective observational study evaluated prophylactic anticoagulation during rehabilitation in patients with TBI aged 16 years or older admitted to 12 TBI Model Systems rehabilitation centers (July 2004-December 2007). After propensity score stratification within center, the odds ratio associated with incidence of symptomatic DVT or pulmonary embolism (PE) for patients who did and did not receive prophylactic anticoagulation was estimated using conditional logistic regression in patients who were not screened for DVT on rehabilitation admission or who screened negative; the analysis was repeated in these two subgroups. RESULTS:: Patients with identified DVTs at rehabilitation admission (n = 266) were excluded, leaving 1,897 patients: 1,002 screened negative, 895 unscreened; 932 received prophylactic anticoagulation, and 965 did not. Symptomatic DVT/PE was detected in 32 patients (15 of 932 [1.6%] with prophylaxis, 17 of 965 [1.8%] without). After propensity score adjustment, the odds ratio (95% confidence interval) for symptomatic DVT/PE with prophylaxis versus no prophylaxis was 0.80 (0.33-1.94) in the full analytic population and 0.46 (0.12-1.84) in the screened-negative subgroup. The only probable venous thromboembolism-related death occurred in the prophylactic anticoagulation group. Fewer new/expanded intracranial hemorrhages occurred among patients who received prophylactic anticoagulation. CONCLUSIONS:: Prophylactic anticoagulation during rehabilitation seemed safe for TBI patients whose physicians deemed it appropriate, but did not conclusively reduce venous thromboembolism. Given the number of DVTs present before rehabilitation, screening and prophylaxis during acute care may be more important.

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KW - Prophylactic anticoagulation

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KW - Venous thromboembolism

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