A Systematic Review of the Risks and Benefits of Venous Thromboembolism Prophylaxis in Traumatic Brain Injury

• Published in: Canadian journal of neurological sciences 2018-07, Vol.45 (4), p.432-444
• Main Authors: Margolick, Joseph, Dandurand, Charlotte, Duncan, Katrina, Chen, Wenjia, Evans, David C., Sekhon, Mypinder S., Garraway, Naisan, Griesdale, Donald E. G., Gooderham, Peter, Hameed, S. Morad
• Format: Article
• Language: English
• Subjects: Anticoagulants; Anticoagulants - therapeutic use; Brain Injuries, Traumatic - complications; Brain research; Cohort analysis; Databases, Bibliographic - statistics & numerical data; Disease prevention; Hospitalization; Humans; Medical imaging; Original Article; Patients; Research design; Systematic review; Thromboembolism; Thrombosis; Trauma; Traumatic brain injury; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2017.275

Background: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of pharmacological venous thromboprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the postinjury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. Methods: MEDLINE and EMBASE databases were searched. Inclusion criteria were studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation. Two investigators extracted data and graded the papers’ levels of evidence. Randomized controlled trials were assessed for bias according to the Cochrane Collaboration Tool and Cohort studies were evaluated for bias using the Newcastle-Ottawa Scale. We performed univariate meta-regression analysis in an attempt to identify a relationship between VTEp timing and hemorrhagic progression and assess study heterogeneity using an I 2 statistic. Results: Twenty-one studies were included in the systematic review. Eighteen total studies demonstrated that VTEp postinjury in patients with stable head computed tomography scan does not lead to TBI progression. Fourteen studies demonstrated that VTEp administration 24 to 72 hours postinjury is safe in patients with stable injury. Four studies suggested that administering VTEp within 24 hours of injury in patients with stable TBI does not lead to progressive intracranial hemorrhage. Overall, meta-regression analysis demonstrated that there was no relationship between rate of hemorrhagic progression and VTEp timing. Conclusions: Literature suggests that administering VTEp 24 to 48 hours postinjury may be safe for patients with low-hemorrhagic-risk TBIs and stable injury on repeat imaging. Revue systématique des risques et des bénéfices de la prophylaxie des tromboembolies veineuses chez les patients atteints d’une lésion cérébrale traumatique. Contexte : Les patients qui ont subi une lésion cérébrale traumatique (LCT) présentent un risque accru de tromboembolie veineuse (TEV). Cependant, l’amorce de la tromboprophylaxie veineuse pharmacologique (TEVp) peut aggraver une hémorragie intracrânienne. Nous avons revu la littérature afin de déterminer le moment après le traumatisme où la TEVp peut être administrée sans risque de provoquer une évolution de la TEV et une expansion de l’hématome. Méthodologie : Nous avons effectué une recherche dans MEDLINE et dans EMBA