Timing of venous thromboembolic pharmacological prophylaxis in traumatic combined subdural and subarachnoid hemorrhage.

Anticoagulants / therapeutic use Head Injuries, Closed / complications Humans Intracranial Hemorrhages Retrospective Studies Subarachnoid Hemorrhage / complications Venous Thromboembolism / etiology
Prophylaxis Subarachnoid hemorrhage Subdural hematoma Venous thromboembolism

Journal

American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473

Informations de publication

Date de publication:
06 2022
Historique:
received: 22 10 2021
revised: 13 11 2021
accepted: 15 11 2021
pubmed: 24 11 2021
medline: 28 6 2022
entrez: 23 11 2021
Statut: ppublish

Résumé

The combination of subdural and subarachnoid hemorrhage is the most common intracranial bleeding. The present study evaluated the timing and type of venous thromboembolic chemoprophylaxis (VTEp) for efficacy and safety in patients with blunt head trauma with combined acute subdural and subarachnoid hemorrhage. Patients with isolated combined acute subdural and subarachnoid hemorrhage were extracted from the ACS-TQIP database (2013-2017). After 1:1 cohort matching of patients receiving early prophylaxis (EP, ≤48 h) versus late prophylaxis (LP, >48 h) outcomes were compared with univariable and multivariable regression analysis. Multivariable regression analysis identified EP as an independent protective factor for VTE complications (OR 0.468, CI 0.293-0.748) but not mortality (p = 0.485). The adjusted risk for delayed craniectomy was not associated with EP compared to LP (p = 0.283). The type of VTEp was not associated with VTE complications (p = 0.301), mortality (p = 0.391) or delayed craniectomy (p = 0.126). Early VTEp (≤48 h) was associated with fewer VTE complications in patients and did not increase the risk for craniectomies in patients with combined acute subdural and subarachnoid hemorrhage.

Sections du résumé

BACKGROUND
The combination of subdural and subarachnoid hemorrhage is the most common intracranial bleeding. The present study evaluated the timing and type of venous thromboembolic chemoprophylaxis (VTEp) for efficacy and safety in patients with blunt head trauma with combined acute subdural and subarachnoid hemorrhage.
METHODS
Patients with isolated combined acute subdural and subarachnoid hemorrhage were extracted from the ACS-TQIP database (2013-2017). After 1:1 cohort matching of patients receiving early prophylaxis (EP, ≤48 h) versus late prophylaxis (LP, >48 h) outcomes were compared with univariable and multivariable regression analysis.
RESULTS
Multivariable regression analysis identified EP as an independent protective factor for VTE complications (OR 0.468, CI 0.293-0.748) but not mortality (p = 0.485). The adjusted risk for delayed craniectomy was not associated with EP compared to LP (p = 0.283). The type of VTEp was not associated with VTE complications (p = 0.301), mortality (p = 0.391) or delayed craniectomy (p = 0.126).
CONCLUSIONS
Early VTEp (≤48 h) was associated with fewer VTE complications in patients and did not increase the risk for craniectomies in patients with combined acute subdural and subarachnoid hemorrhage.

Identifiants

DOI: 10.1016/j.amjsurg.2021.11.021 PMID: 34809908
pubmed: 34809908
pii: S0002-9610(21)00679-6
doi: 10.1016/j.amjsurg.2021.11.021
pii:
doi:

Substances chimiques

Anticoagulants 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1194-1199

Informations de copyright

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Auteurs

Dominik A Jakob (DA)

Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California Medical Center, University of Southern California Los Angeles, Los Angeles, CA, 90033, USA; Department of Emergency Medicine, Inselspital University of Bern, Freiburgstrasse 16C, 3010, Bern, Switzerland. Electronic address: Dominik.a.jakob@gmail.com.

Meghan Lewis (M)

Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California Medical Center, University of Southern California Los Angeles, Los Angeles, CA, 90033, USA. Electronic address: Meghan.Lewis@med.usc.edu.

Elizabeth R Benjamin (ER)

Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California Medical Center, University of Southern California Los Angeles, Los Angeles, CA, 90033, USA. Electronic address: Erbenjamin1@gmail.com.

Delbrynth P Mitchao (DP)

Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California Medical Center, University of Southern California Los Angeles, Los Angeles, CA, 90033, USA. Electronic address: Delbrynth.mitchao@icloud.com.

Aristomenis K Exadaktylos (AK)

Department of Emergency Medicine, Inselspital University of Bern, Freiburgstrasse 16C, 3010, Bern, Switzerland. Electronic address: Aristomenis.Exadaktylos@insel.ch.

Demetrios Demetriades (D)

Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California Medical Center, University of Southern California Los Angeles, Los Angeles, CA, 90033, USA. Electronic address: Demetrios.Demetriades@med.usc.edu.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Timing of venous thromboembolic...
questionsmedicales.fr › Plaies et blessures › Plaies non pénétrantes › Traumatismes crâniens fermés › Timing of venous thromboembolic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Timing of venous thromboembolic...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Hémorragies intracrâniennes › Timing of venous thromboembolic...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Timing of venous thromboembolic...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Hémorragies intracrâniennes › Hémorragie meningée › Timing of venous thromboembolic...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Thromboembolie › Thromboembolisme veineux › Timing of venous thromboembolic...