Impact of practice change in reducing venous thromboembolism in neurocritical overweight patients: 2008-2014.
Publications regarding early initiating venous thromboembolism (VTE) prophylaxis have been available since the early 1990s. These recommendations became available in current guidelines on and after 2012. The purpose of this study is to review the practice change in reducing the incidence of VTE in brain injury patients from 2008 to 2014. This was a single-center, retrospective, observational, cohort study. Data was extracted from our data base that included patients over 100 kg from January 2008 to August 2014. Included were all patients admitted with a primary diagnosis of acute brain and spinal injury to neurocritical care unit. Clinical endpoints examined were incidence of bleeding and VTE. A total of 509 patients who met the inclusion criteria were divided into two groups: The previous group (n = 212) included patients from 2008 to 2010, and the recent group (n = 297) included patients from 2011 to 2014. The time for initiating VTE prophylaxis from admission was (median, IQR) 73 h (37-140) vs. 34 h (20-46); p < 0.01. There were no differences in major and minor bleeding complications. Discontinuation of VTE prophylaxis for association with progressive bleeding was not documented in any of the study patients. The incidence of VTE was 10 % (22/212) vs. 5 % (15/297); p = 0.02. In hospital LOS in days was 16 (10-26) vs. 7 (4-15); P < 0.01. In multivariable logistic regression analysis, only the time of the initiation VTE prophylaxis after admission was significantly associated with the occurrence of VTE (median, IQR) 70 h (37-158) vs. 36 h (20-63); OR 1.004, 95 % CI 1.001-1.007; P < 0.01. In this 6-year review of data, early initiation of VTE prophylaxis has decreased the incidence of VTE without clinically documented bleeding complications.
Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77054, USA. Sophie.samuel@memorialhermann.org.
Sophie
S
Samuel
Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, Houston, USA.
Suhas
S
Bajgur
Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, Houston, USA.
Jude P
JP
Savarraj
Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, Houston, USA.
Huimahn A
HA
Choi
D000328:Adult; D001930:Brain Injuries / Q000150:complications; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications*; D017410:Practice Guidelines as Topic / Q000592:standards; D011292:Premedication / Q000379:methods; D012044:Regression Analysis; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000150:complications; D013997:Time Factors; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
Heparin; Neurosurgery; Risk factors; Venous thromboembolism