title: Pharmacologic thromboprophylaxis is a risk factor for hemorrhage progression in a subset of patients with traumatic brain injury.
abstract: BACKGROUND
  Pharmacologic thromboprophylaxis (PTP) may exacerbate intracranial hemorrhage (ICH) in patients with traumatic brain injury (TBI). We examined risk factors for hemorrhage progression in patients with blunt TBI and hypothesized that PTP would increase ICH progression in a subset of these patients.
  
  
  METHODS
  We retrospectively studied patients with TBI admitted to our level I trauma center during 19 months. Progression of hemorrhage was examined in two populations: patients with a stable initial follow-up (F/U) computed tomography (CT) and patients with hemorrhage progression on initial F/U CT. Risk factors potentially associated with hemorrhage progression were analyzed using logistic regression. Timing of PTP was defined two ways: exposed to PTP versus not exposed; early (<72 hours), late (>or=72 hours), or no PTP.
  
  
  RESULTS
  Three hundred forty patients with TBI were reviewed and hemorrhage progression occurred in 32.4% (n = 110) of patients of which 59.1% were considered clinically significant. In patients with ICH progression on initial F/U CT, predictors of subsequent hemorrhage progression include exposure to PTP (odds ratio [OR]: 13.07, p = 0.01), extradural/subdural hemorrhage (OR: 5.15, p = 0.03), Glasgow Coma Score 3-8 (OR: 4.64, p = 0.03), and body mass index >or=25 (OR = 4.32, p = 0.03). PTP was not significantly associated with hemorrhage progression in patients with a stable initial F/U CT.
  
  
  CONCLUSIONS
  These findings suggest that PTP use is associated with a 13-fold increased odds of further hemorrhage progression in patients whose F/U CT within 1 day of admission showed ICH progression; 16% of this risk can be attributed to receiving PTP. Conversely, PTP may be safe in a subgroup of patients with TBI with no ICH progression on initial F/U CT.
authors.affiliation: InterMountain Neurosurgery, St. Anthony Central Hospital, Denver, Colorado, USA.
authors.forename: Andrew Stewart
authors.initials: AS
authors.lastname: Levy
authors.forename: Kristin
authors.initials: K
authors.lastname: Salottolo
authors.forename: Raphael
authors.initials: R
authors.lastname: Bar-Or
authors.forename: Patrick
authors.initials: P
authors.lastname: Offner
authors.forename: Charles
authors.initials: C
authors.lastname: Mains
authors.forename: Michael
authors.initials: M
authors.lastname: Sullivan
authors.forename: David
authors.initials: D
authors.lastname: Bar-Or
mesh_terms: D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed