title: Safety of Chemical DVT Prophylaxis in Severe Traumatic Brain Injury with Invasive Monitoring Devices.
abstract: Patients with traumatic brain injuries (TBIs) have an increased risk of developing a deep vein thrombosis (DVT), but the risk of hemorrhage expansion with intracranial monitoring devices remains unknown. We sought to determine the safety of chemical DVT prophylaxis in severe TBI patients with invasive intracranial pressure monitors.
  
  
  
  We retrospectively reviewed all patients with severe TBI admitted to the neurosurgical intensive care unit of a large tertiary care center over a three-year period.
  
  
  
  155 patients were included with an incidence of DVT of 12 %. The median length of time to a stable head CT was 2 days, and the median time to initiation of chemical DVT prophylaxis was 3.6 days. The odds of DVT increased with intraparenchymal hemorrhage [OR 7.21, 95 % CI (1.43-36.47), p = 0.0169], non-White ethnicity [OR 7.86, 95 % CI (1.23-50.35), p = 0.0295], female gender [OR 13.93, 95 % CI (2.47-78.73), p = 0.0029], smoking [OR 4.32, 95 % CI (1.07-17.51), p = 0.0405], no anticoagulation [OR 25.39, 95 % CI (4.26-151.48), p < 0.001], and an IVC filter [OR 15.82, 95 % CI (3.14-79.76), p < 0.001]. Twenty-eight (18 %) of these subjects experienced in-hospital mortality. The risk of in-hospital death was significantly increased among those who did not receive anticoagulation. This study found no association between DVT formation, hemorrhage expansion, or increased risk from invasive monitoring devices between various doses of unfractionated heparin (UH) and low-molecular-weight heparin (LMWH).
  
  
  
  We conclude that DVT prophylaxis with either LMWH or UH is safe with intracranial pressure monitors in place.
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Mail Code 7843, 7703 Floyd Curl Drive (MC7843), San Antonio, TX, 78229, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Dengler
authors.affiliation: School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mendez-Gomez
authors.affiliation: School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Chavez
authors.affiliation: School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Lacey
authors.initials: L
authors.lastname: Avila
authors.affiliation: Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Michalek
authors.affiliation: Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Hernandez
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Mail Code 7843, 7703 Floyd Curl Drive (MC7843), San Antonio, TX, 78229, USA.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Grandhi
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Mail Code 7843, 7703 Floyd Curl Drive (MC7843), San Antonio, TX, 78229, USA. seifi@uthscsa.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Seifi
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000209:etiology / Q000401:mortality; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D064926:Neurophysiological Monitoring / Q000009:adverse effects*; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Deep vein thrombosis; Intracranial pressure monitor; Severe traumatic brain injury