Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging
Background: Venous thromboembolic prophylaxis (VTEp) is often delayed following traumatic brain injury (TBI), yet animal data suggest that it may reduce cerebral inflammation and improve cognitive recovery. We hypothesized that earlier VTEp initiation in severe TBI patients would result in more rapi...
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Wolters Kluwer Medknow Publications
2014-01-01
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doaj-4dcac04aebb140ec82ab05a5614c41572020-11-24T22:29:37ZengWolters Kluwer Medknow PublicationsJournal of Emergencies, Trauma and Shock0974-27002014-01-017314114810.4103/0974-2700.136846Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imagingLuke KimJames SchusterDaniel N HolenaCarrie A SimsJoshua LevineJose L PascualBackground: Venous thromboembolic prophylaxis (VTEp) is often delayed following traumatic brain injury (TBI), yet animal data suggest that it may reduce cerebral inflammation and improve cognitive recovery. We hypothesized that earlier VTEp initiation in severe TBI patients would result in more rapid neurologic recovery and reduced progression of brain injury on radiologic imaging. Study Design: Medical charts of severe TBI patients admitted to a level 1 trauma center in 2009-2010 were queried for admission Glasgow Coma Scale (GCS), head Abbreviated Injury Scale, Injury Severity Score (ISS), osmotherapy use, emergency neurosurgery, and delay to VTEp initiation. Progression (+1 = better, 0 = no change, −1 = worse) of brain injury on head CTs and neurologic exam (by bedside MD, nurse) was collected from patient charts. Head CT scan Marshall scores were calculated from the initial head CT results. Results: A total of 22, 34, and 19 patients received VTEp at early (<3 days), intermediate (3-5 days), and late (>5 days) time intervals, respectively. Clinical and radiologic brain injury characteristics on admission were similar among the three groups (P > 0.05), but ISS was greatest in the early group (P < 0.05). Initial head CT Marshall scores were similar in early and late groups. The slowest progression of brain injury on repeated head CT scans was in the early VTEp group up to 10 days after admission. Conclusion: Early initiation of prophylactic heparin in severe TBI is not associated with deterioration neurologic exam and may result in less progression of injury on brain imaging. Possible neuroprotective effects of heparin in humans need further investigation.http://www.onlinejets.org/article.asp?issn=0974-2700;year=2014;volume=7;issue=3;spage=141;epage=148;aulast=KimHeparinintracranial hemorrhagetraumatic brain injuryVTE prophylaxis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Luke Kim James Schuster Daniel N Holena Carrie A Sims Joshua Levine Jose L Pascual |
spellingShingle |
Luke Kim James Schuster Daniel N Holena Carrie A Sims Joshua Levine Jose L Pascual Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging Journal of Emergencies, Trauma and Shock Heparin intracranial hemorrhage traumatic brain injury VTE prophylaxis |
author_facet |
Luke Kim James Schuster Daniel N Holena Carrie A Sims Joshua Levine Jose L Pascual |
author_sort |
Luke Kim |
title |
Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging |
title_short |
Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging |
title_full |
Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging |
title_fullStr |
Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging |
title_full_unstemmed |
Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging |
title_sort |
early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging |
publisher |
Wolters Kluwer Medknow Publications |
series |
Journal of Emergencies, Trauma and Shock |
issn |
0974-2700 |
publishDate |
2014-01-01 |
description |
Background: Venous thromboembolic prophylaxis (VTEp) is often delayed following traumatic brain injury (TBI), yet animal data suggest that it may reduce cerebral inflammation and improve cognitive recovery. We hypothesized that earlier VTEp initiation in severe TBI patients would result in more rapid neurologic recovery and reduced progression of brain injury on radiologic imaging. Study Design: Medical charts of severe TBI patients admitted to a level 1 trauma center in 2009-2010 were queried for admission Glasgow Coma Scale (GCS), head Abbreviated Injury Scale, Injury Severity Score (ISS), osmotherapy use, emergency neurosurgery, and delay to VTEp initiation. Progression (+1 = better, 0 = no change, −1 = worse) of brain injury on head CTs and neurologic exam (by bedside MD, nurse) was collected from patient charts. Head CT scan Marshall scores were calculated from the initial head CT results. Results: A total of 22, 34, and 19 patients received VTEp at early (<3 days), intermediate (3-5 days), and late (>5 days) time intervals, respectively. Clinical and radiologic brain injury characteristics on admission were similar among the three groups (P > 0.05), but ISS was greatest in the early group (P < 0.05). Initial head CT Marshall scores were similar in early and late groups. The slowest progression of brain injury on repeated head CT scans was in the early VTEp group up to 10 days after admission. Conclusion: Early initiation of prophylactic heparin in severe TBI is not associated with deterioration neurologic exam and may result in less progression of injury on brain imaging. Possible neuroprotective effects of heparin in humans need further investigation. |
topic |
Heparin intracranial hemorrhage traumatic brain injury VTE prophylaxis |
url |
http://www.onlinejets.org/article.asp?issn=0974-2700;year=2014;volume=7;issue=3;spage=141;epage=148;aulast=Kim |
work_keys_str_mv |
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