title: Chemoprophylaxis for venous thromboembolism in traumatic brain injury: a review and evidence-based protocol.
abstract: Venous thromboembolism (VTE) is a recognized source of morbidity and mortality in patients suffering traumatic brain injury (TBI). While traumatic brain injury is a recognized risk factor for the development of VTE, its presence complicates the decision to begin anticoagulation due to fear of exacerbating the intracranial hemorrhagic injury. The role of chemoprophylaxis in this setting is poorly defined, leading to a wide variability in clinical practice. A comprehensive review of the literature was performed in an effort to summarize relevant data and construct a chemoprophylaxis protocol to be implemented in a Level I Trauma Center. The review reveals robust evidence regarding the safety and efficacy of chemoprophylaxis in the setting of TBI following demonstration of a stable intracranial injury. In light of this data, a protocol is assembled that, in the absence of predetermined exclusion criteria, will initiate chemoprophylaxis within 24h after the demonstration of a stable intracranial injury by computed tomography (CT).
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama, 1530 3rd Avenue S, Birmingham, AL 35294, USA. Electronic address: pforeman@uabmc.edu.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Foreman
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama, 1530 3rd Avenue S, Birmingham, AL 35294, USA.
authors.forename: Philip G R
authors.initials: PG
authors.lastname: Schmalz
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama, 1530 3rd Avenue S, Birmingham, AL 35294, USA.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000601:surgery*; D018890:Chemoprevention / Q000379:methods; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000150:complications / Q000517:prevention & control* / Q000628:therapy*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Deep venous thrombosis; Head trauma; Prophylaxis; Traumatic brain injury