Safety of Chemical DVT Prophylaxis in Severe Traumatic Brain Injury with Invasive Monitoring Devices

Bradley A. Dengler, Paolo Mendez-Gomez, Amanda Chavez, Lacey Avila, Joel E Michalek, Brian Hernandez, Ramesh Grandhi, Ali Seifi

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background: 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. Methods: 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. Results: 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). Conclusion: We conclude that DVT prophylaxis with either LMWH or UH is safe with intracranial pressure monitors in place.

Original languageEnglish (US)
Pages (from-to)215-223
Number of pages9
JournalNeurocritical Care
Volume25
Issue number2
DOIs
StatePublished - Oct 1 2016

Keywords

  • Deep vein thrombosis
  • Intracranial pressure monitor
  • Severe traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Safety of Chemical DVT Prophylaxis in Severe Traumatic Brain Injury with Invasive Monitoring Devices'. Together they form a unique fingerprint.

  • Cite this

    Dengler, B. A., Mendez-Gomez, P., Chavez, A., Avila, L., Michalek, J. E., Hernandez, B., Grandhi, R., & Seifi, A. (2016). Safety of Chemical DVT Prophylaxis in Severe Traumatic Brain Injury with Invasive Monitoring Devices. Neurocritical Care, 25(2), 215-223. https://doi.org/10.1007/s12028-016-0280-8