Skip to main content
SpringerLink
Log in

Impact of practice change in reducing venous thromboembolism in neurocritical overweight patients: 2008–2014

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Publications regarding early initiating venous thromboembolism (VTE) prophylaxis have been available since the early 1990s. These recommendations became available in current guidelines on and after 2012. The purpose of this study is to review the practice change in reducing the incidence of VTE in brain injury patients from 2008 to 2014. This was a single-center, retrospective, observational, cohort study. Data was extracted from our data base that included patients over 100 kg from January 2008 to August 2014. Included were all patients admitted with a primary diagnosis of acute brain and spinal injury to neurocritical care unit. Clinical endpoints examined were incidence of bleeding and VTE. A total of 509 patients who met the inclusion criteria were divided into two groups: The previous group (n = 212) included patients from 2008 to 2010, and the recent group (n = 297) included patients from 2011 to 2014. The time for initiating VTE prophylaxis from admission was (median, IQR) 73 h (37–140) vs. 34 h (20–46); p < 0.01. There were no differences in major and minor bleeding complications. Discontinuation of VTE prophylaxis for association with progressive bleeding was not documented in any of the study patients. The incidence of VTE was 10 % (22/212) vs. 5 % (15/297); p = 0.02. In hospital LOS in days was 16 (10–26) vs. 7 (4–15); P < 0.01. In multivariable logistic regression analysis, only the time of the initiation VTE prophylaxis after admission was significantly associated with the occurrence of VTE (median, IQR) 70 h (37–158) vs. 36 h (20–63); OR 1.004, 95 % CI 1.001–1.007; P < 0.01. In this 6-year review of data, early initiation of VTE prophylaxis has decreased the incidence of VTE without clinically documented bleeding complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Frim DM, Barker FG, Poletti CE, Hamilton AJ (1992) Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients. Neurosurgery 30:830–832 (discussion 832–3)

    Article  CAS  PubMed  Google Scholar 

  2. Hamilton MG, Hull RD, Pineo GF (1994) Venous thromboembolism in neurosurgery and neurology patients: a review. Neurosurgery 34:280–296 (discussion 296)

    Article  CAS  PubMed  Google Scholar 

  3. Goldhaber SZ, Dunn K, Gerhard-Herman M et al (2002) Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis. Chest 122:1933–1937

    Article  PubMed  Google Scholar 

  4. Skaf E, Stein PD, Beemath A et al (2005) Venous thromboembolism in patients with ischemic and hemorrhagic stroke. Am J Cardiol 96:1731–1733. doi:10.1016/j.amjcard.2005.07.097

    Article  PubMed  Google Scholar 

  5. Kappelle LJ (2011) Preventing deep vein thrombosis after stroke: strategies and recommendations. Curr Treat Options Neurol 13:629–635. doi:10.1007/s11940-011-0147-4

    Article  PubMed  PubMed Central  Google Scholar 

  6. Phelan HA (2012) Pharmacologic venous thromboembolism prophylaxis after traumatic brain injury: a critical literature review. J Neurotrauma 29:1821–1828. doi:10.1089/neu.2012.2459

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kiphuth IC, Staykov D, Köhrmann M et al (2009) Early administration of low molecular weight heparin after spontaneous intracerebral hemorrhage. A safety analysis. Cerebrovasc Dis 27:146–150. doi:10.1159/000177923

    Article  CAS  PubMed  Google Scholar 

  8. Wu T-C, Kasam M, Harun N et al (2011) Pharmacological deep vein thrombosis prophylaxis does not lead to hematoma expansion in intracerebral hemorrhage with intraventricular extension. Stroke 42:705–709. doi:10.1161/STROKEAHA.110.600593

    Article  PubMed  Google Scholar 

  9. Raabe A, Gerlach R, Zimmermann M, Seifert V (2001) The risk of haemorrhage associated with early postoperative heparin administration after intracranial surgery. Acta Neurochir 143:1–7

    Article  CAS  Google Scholar 

  10. Dickinson LD, Miller LD, Patel CP, Gupta SK (1998) Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors. Neurosurgery 43:1074–1081

    Article  CAS  PubMed  Google Scholar 

  11. Lacut K, Bressollette L, Le Gal G et al (2005) Prevention of venous thrombosis in patients with acute intracerebral hemorrhage. Neurology 65:865–869. doi:10.1212/01.wnl.0000176073.80532.a2

    Article  CAS  PubMed  Google Scholar 

  12. Boeer A, Voth E, Henze T, Prange HW (1991) Early heparin therapy in patients with spontaneous intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 54:466–467

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Dickmann U, Voth E, Schicha H et al (1988) Heparin therapy, deep-vein thrombosis and pulmonary embolism after intracerebral hemorrhage. Klin Wochenschr 66:1182–1183

    Article  CAS  PubMed  Google Scholar 

  14. Mesa-Galán LA, Egea-Guerrero JJ, Vilches-Arenas A, Quintana-Diaz M (2016) The effectiveness and safety of pharmacological prophylaxis against venous thromboembolism in patients with moderate-to-severe traumatic brain injury: a systematic review and meta-analysis. J Trauma Acute Care Surg. doi:10.1097/TA.0000000000001134

    PubMed  Google Scholar 

  15. Samuel S, Iluonakhamhe EK, Adair E et al (2015) High dose subcutaneous unfractionated heparin for prevention of venous thromboembolism in overweight neurocritical care patients. J Thromb Thrombolysis 40:302–307. doi:10.1007/s11239-015-1202-x

    Article  CAS  PubMed  Google Scholar 

  16. Jauch EC, Saver JL, Adams HP et al (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44:870–947. doi:10.1161/STR.0b013e318284056a

    Article  PubMed  Google Scholar 

  17. Lansberg MG, O’Donnell MJ, Khatri P et al (2012) Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141:e601S–e601S36S. doi:10.1378/chest.11-2302

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hemphill JC, Greenberg SM, Anderson CS et al (2015) Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke 46:2032–2060. doi:10.1161/STR.0000000000000069

    Article  PubMed  Google Scholar 

  19. Connolly ES, Rabinstein AA, Carhuapoma JR et al (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 43:1711–1737. doi:10.1161/STR.0b013e3182587839

    Article  PubMed  Google Scholar 

  20. Nyquist P, Bautista C, Jichici D et al (2016) Prophylaxis of venous thrombosis in neurocritical care patients: an evidence-based guideline: a statement for healthcare professionals from the neurocritical care society. Neurocrit Care 24:47–60. doi:10.1007/s12028-015-0221-y

    Article  PubMed  Google Scholar 

  21. Ann M guidelines for the management of severe traumatic brain injury 3rd Edition

  22. Joy M, Tharp E, Hartman H et al (2016) Safety and efficacy of high-dose unfractionated heparin for prevention of venous thromboembolism in overweight and obese patients. Pharmacotherapy. doi:10.1002/phar.1775

    PubMed  Google Scholar 

  23. Cohen AT, Spiro TE, Büller HR et al (2013) Rivaroxaban for thromboprophylaxis in acutely Ill medical patients. N Engl J Med 368:513–523. doi:10.1056/NEJMoa1111096

    Article  CAS  PubMed  Google Scholar 

  24. Wang T-F, Milligan PE, Wong CA et al (2014) Efficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients. Thromb Haemost 111:88–93. doi:10.1160/TH13-01-0042

    Article  CAS  PubMed  Google Scholar 

  25. Henwood PC, Kennedy TM, Thomson L et al (2011) The incidence of deep vein thrombosis detected by routine surveillance ultrasound in neurosurgery patients receiving dual modality prophylaxis. J Thromb Thrombolysis 32:209–214. doi:10.1007/s11239-011-0583-8

    Article  PubMed  Google Scholar 

Download references

Author contribution

S. Samuel: study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. S. Bajgur: analysis and interpretation, critical revision of the manuscript for important intellectual content. J. Savarraj: analysis and interpretation, critical revision of the manuscript for important intellectual content. H. Choi: study concept and design, analysis and interpretation, critical revision of the manuscript for important intellectual content.

Author information

Authors and Affiliations

  1. Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77054, USA

    Sophie Samuel

  2. Department of Neurosurgery and Neurology, The University of Texas Medical School at Houston, Houston, USA

    Suhas Bajgur, Jude P. Savarraj & Huimahn A. Choi

Authors
  1. Sophie Samuel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suhas Bajgur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jude P. Savarraj
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huimahn A. Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sophie Samuel.

Ethics declarations

Conflict of interest

Sophie Samuel, Suhas Bajgur, Jude P. Savarraj and Huimahn. A. Choi declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Samuel, S., Bajgur, S., Savarraj, J.P. et al. Impact of practice change in reducing venous thromboembolism in neurocritical overweight patients: 2008–2014. J Thromb Thrombolysis 43, 98–104 (2017). https://doi.org/10.1007/s11239-016-1422-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-016-1422-8

Keywords

Search

Navigation