Progression of Intracranial Hemorrhage After Chemical Prophylaxis Using Low-Molecular-Weight Heparin in Patients With Traumatic Brain Injury

2021 ◽  
pp. 000313482110540
Author(s):  
Zachary T. Thier ◽  
Kelan Drake-Lavelle ◽  
Phillip J. Prest ◽  
Mark A. Jones ◽  
Jeremy M. Reeves ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Brain Injury ◽  
Intracranial Hemorrhage ◽  
Clinical Management ◽  
Low Molecular Weight Heparin ◽  
Radiographic Progression ◽  
Pupillary Response ◽  
Low Molecular Weight ◽  
Chemical Prophylaxis

Introduction Chemical prophylaxis using low-molecular-weight heparin (LMWH) is considered a standard of care for venous thromboembolism in trauma patients. Our center performs a head computed tomography (CT) scan 24 hours after initiation with prophylactic LMWH in the setting of a known traumatic brain injury (TBI). The purpose was to determine the overall incidence of ICH progression after chemoprophylaxis in patients with a TBI. Methods This retrospective study was performed at a Level I trauma center, from 1/1/2014 to 12/31/2017. Study patients were drawn from the institution’s trauma registry based on Abbreviated Injury Score codes. Results 778 patients met all inclusion criteria after initial chart review. The proportion of patients with an observed radiographic progression of intracranial hemorrhage after LMWH was 5.8%. 3.1% of patients had a change in clinical management. Observed radiographic progression after LMWH prophylaxis and the presence of SDH on initial CT, the bilateral absence of pupillary response in the emergency department, and a diagnosis of dementia were found to have statistically significant correlation with bleed progression after LMWH was initiated. Conclusion Over a 4-year period, the use of CT to evaluate for radiographic progression of traumatic intracranial hemorrhage 24 hours after receiving LMWH resulted in a change in clinical management for 3.1% of patients. The odds of intracranial hemorrhage progression were approximately 6.5× greater in patients with subdural hemorrhage on initial CT, 3.1× greater in patients with lack of bilateral pupillary response in ED, and 4.2× greater in patients who had been diagnosed with dementia.

Low-molecular-weight heparin versus unfractionated heparin in pediatric traumatic brain injury

2021 ◽  
pp. 1-6
Author(s):  
Inge A. van Erp ◽  
Apostolos Gaitanidis ◽  
Mohamad El Moheb ◽  
Haytham M. A. Kaafarani ◽  
Noelle Saillant ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Brain Injury ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Pediatric Patients ◽  
Low Molecular Weight ◽  
Improvement Program ◽  
Vte Prophylaxis ◽  
Pediatric Tbi

OBJECTIVEThe incidence of venous thromboembolism (VTE) in patients with traumatic brain injury (TBI) has increased significantly. The Eastern Association for the Surgery of Trauma recommends using low-molecular-weight heparin (LMWH) over unfractionated heparin (UH) in pediatric patients requiring VTE prophylaxis, although this strategy is unsupported by the literature. In this study, the authors compare the outcomes of pediatric TBI patients receiving LMWH versus UH.METHODSThe authors performed a 4-year (2014–2017) analysis of the pediatric American College of Surgeons Trauma Quality Improvement Program. All trauma patients (age ≤ 18 years) with TBI requiring thromboprophylaxis with UH or LMWH were potentially eligible for inclusion. Patients who had been transferred, had died in the emergency department, or had penetrating trauma were excluded. Patients were stratified into either the LMWH or the UH group on the basis of the prophylaxis they had received. Patients were matched on the basis of demographics, injury characteristics, vital signs, and transfusion requirements using propensity score matching (PSM). The study endpoints were VTE, death, and craniotomy after initiation of prophylaxis. Univariate analysis was performed after PSM to compare outcomes.RESULTSA total of 2479 patients met the inclusion criteria (mean age 15.5 ± 3.7 years and 32.0% female), of which 1570 (63.3%) had received LMWH and 909 (36.7%) had received UH. Before PSM, patients receiving UH were younger, had a lower Glasgow Coma Scale score, and had a higher Injury Severity Score. Patients treated in pediatric hospitals were more likely to receive UH (12.9% vs 9.0%, p < 0.001) than patients treated in adult hospitals. Matched patients receiving UH had a higher incidence of VTE (5.1% vs 2.9%, p = 0.03).CONCLUSIONSLMWH prophylaxis in pediatric TBI appears to be more effective than UH in preventing VTE. Large, multicenter prospective studies are warranted to confirm the superiority of LMWH over UH in pediatric patients with TBI. Moreover, outcomes of VTE prophylaxis in the very young remain understudied; therefore, dedicated studies to evaluate this population are needed.

Early Anti-Xa Assay-Guided Low Molecular Weight Heparin Chemoprophylaxis is Safe in Adult Patients with Acute Traumatic Brain Injury

2020 ◽  
Vol 86 (4) ◽  
pp. 369-376
Author(s):  
Simon G. Rodier ◽  
Mirhee Kim ◽  
Samantha Moore ◽  
Spiros G. Frangos ◽  
Manish Tandon ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Quality Improvement ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Dose Group ◽  
Factor Xa ◽  
Fixed Dose ◽  
Low Molecular Weight ◽  
Improvement Project

This study evaluated the safety of early anti-factor Xa assay–guided enoxaparin dosing for chemoprophylaxis in patients with TBI. We hypothesized that assay-guided chemoprophylaxis would be comparable in the risk of intracranial hemorrhage (ICH) progression to fixed dosing. An observational analysis of adult patients with blunt traumatic brain injury (TBI) was performed at a Level I trauma center from August 2016 to September 2017. Patients in the assay-guided group were treated with an initial enoxaparin dose of 0.5 mg/kg, with peak anti-factor Xa activity measured four hours after the third dose. Prophylactic range was defined as 0.2 to 0.5 IU/mL with a dose adjustment of ± 10 mg based on the assay result. The assay-guided group was compared with historical fixed-dose controls and to a TBI cohort from the most recent Trauma Quality Improvement Project dataset. Of 179 patients included in the study, 85 were in the assay-guided group and 94 were in the fixed-dose group. Compared with the fixed-dose group, the assay-guided group had a lower Glasgow Coma Score and higher Injury Severity Score. The proportion of severe (Abbreviated Injury Score, head ≥3) TBI, ICH progression, and venous thromboembolism rates were similar between all groups. The assay-guided and fixed-dose groups had chemoprophylaxis initiated earlier than the Trauma Quality Improvement Project group. The assay-guided group had the highest percentage of low molecular weight heparin use. Early initiation of enoxaparin anti-factor Xa assay–guided venous thromboembolism chemoprophylaxis has a comparable risk of ICH progression to fixed dosing in patients with TBI. These findings should be validated prospectively in a multicenter study.

scholarly journals Low Molecular Weight Dextran Sulfate (ILB®) Administration Restores Brain Energy Metabolism Following Severe Traumatic Brain Injury in the Rat

Antioxidants ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 850
Author(s):  
Giacomo Lazzarino ◽  
Angela Maria Amorini ◽  
Nicholas M. Barnes ◽  
Lars Bruce ◽  
Alvaro Mordente ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Brain Injury ◽  
Energy Metabolism ◽  
Nitrosative Stress ◽  
Dextran Sulfate ◽  
Subcutaneous Administration ◽  
Water Soluble ◽  
Low Molecular Weight ◽  
Post Injury

Traumatic brain injury (TBI) is the leading cause of death and disability in people less than 40 years of age in Western countries. Currently, there are no satisfying pharmacological treatments for TBI patients. In this study, we subjected rats to severe TBI (sTBI), testing the effects of a single subcutaneous administration, 30 min post-impact, of a new low molecular weight dextran sulfate, named ILB®, at three different dose levels (1, 5, and 15 mg/kg body weight). A group of control sham-operated animals and one of untreated sTBI rats were used for comparison (each group n = 12). On day 2 or 7 post-sTBI animals were sacrificed and the simultaneous HPLC analysis of energy metabolites, N-acetylaspartate (NAA), oxidized and reduced nicotinic coenzymes, water-soluble antioxidants, and biomarkers of oxidative/nitrosative stress was carried out on deproteinized cerebral homogenates. Compared to untreated sTBI rats, ILB® improved energy metabolism by increasing ATP, ATP/ adenosine diphosphate ratio (ATP/ADP ratio), and triphosphate nucleosides, dose-dependently increased NAA concentrations, protected nicotinic coenzyme levels and their oxidized over reduced ratios, prevented depletion of ascorbate and reduced glutathione (GSH), and decreased oxidative (malondialdehyde formation) and nitrosative stress (nitrite + nitrate production). Although needing further experiments, these data provide the first evidence that a single post-injury injection of a new low molecular weight dextran sulfate (ILB®) has beneficial effects on sTBI metabolic damages. Due to the absence of adverse effects in humans, ILB® represents a promising therapeutic agent for the treatment of sTBI patients.

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