title: Venous thromboembolic events in critically ill traumatic brain injury patients.
abstract: OBJECTIVE
  To estimate the prevalence, risk factors, prophylactic treatment and impact on mortality for venous thromboembolism (VTE) in patients with moderate to severe traumatic brain injury (TBI) treated in the intensive care unit.
  
  
  METHODS
  A post hoc analysis of the erythropoietin in traumatic brain injury (EPO-TBI) trial that included twice-weekly lower limb ultrasound screening. Venous thrombotic events were defined as ultrasound-proven proximal deep venous thrombosis (DVT) or clinically detected pulmonary embolism (PE). Results are reported as events, percentages or medians and interquartile range (IQR). Cox regression analysis was used to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI) for time to VTE and death.
  
  
  RESULTS
  Of 603 patients, 119 (19.7%) developed VTE, mostly comprising DVT (102 patients, 16.9%) with a smaller number of PE events (24 patients, 4.0%). Median time to DVT diagnosis was 6 days (IQR 2-11) and to PE diagnosis 6.5 days (IQR 2-16.5). Mechanical prophylaxis (MP) was used in 91% of patients on day 1, 97% of patients on day 3 and 98% of patients on day 7. Pharmacological prophylaxis was given in 5% of patients on day 1, 30% of patients on day 3 and 57% of patients on day 7. Factors associated with time to VTE were age (HR per year 1.02, 95% CI 1.01-1.03), patient weight (HR per kg 1.01, 95% CI 1-1.02) and TBI severity according to the International Mission for Prognosis and Analysis of Clinical Trials risk of poor outcome (HR per 10% increase 1.12, 95% CI 1.01-1.25). The development of VTE was not associated with mortality (HR 0.92, 95% CI 0.51-1.65).
  
  
  CONCLUSIONS
  Despite mechanical and pharmacological prophylaxis, VTE occurs in one out of every five patients with TBI treated in the ICU. Higher age, greater weight and greater severity of TBI increase the risk. The development of VTE was not associated with excess mortality.
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia. markus.skrifvars@monash.edu.|Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland. markus.skrifvars@monash.edu.
authors.forename: Markus B
authors.initials: MB
authors.lastname: Skrifvars
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.|Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Presneill
authors.affiliation: Department of Intensive Care, Western Health, Melbourne, VIC, Australia.|University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: French
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.|School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.|Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
authors.forename: Alistair
authors.initials: A
authors.lastname: Nichol
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Little
authors.affiliation: Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Assistance Publique des Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, CHRU La Cavale Blanche, Université de Bretagne Occidentale, Brest, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Huet
authors.affiliation: King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors.forename: Samir
authors.initials: S
authors.lastname: Haddad
authors.affiliation: King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Arabi
authors.affiliation: Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Colin
authors.initials: C
authors.lastname: McArthur
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.|Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
authors.forename: D James
authors.initials: DJ
authors.lastname: Cooper
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.|Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications*; D016638:Critical Illness; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D018608:Ultrasonography, Doppler; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D055815:Young Adult
keywords: Deep venous thrombosis; Erythropoietin; Pulmonary embolism; Traumatic brain injury; Venous thromboembolism