Intensive Care Medicine

, Volume 43, Issue 3, pp 419–428 | Cite as

Venous thromboembolic events in critically ill traumatic brain injury patients

  • Markus B. Skrifvars
  • Michael Bailey
  • Jeffrey Presneill
  • Craig French
  • Alistair Nichol
  • Lorraine Little
  • Jacques Duranteau
  • Olivier Huet
  • Samir Haddad
  • Yaseen Arabi
  • Colin McArthur
  • D. James Cooper
  • Rinaldo Bellomo
  • For the EPO-TBI investigators and the ANZICS Clinical Trials Group
Original

Abstract

Purpose

To estimate the prevalence, risk factors, prophylactic treatment and impact on mortality for venous thromboembolism (VTE) in patients with moderate to severe traumatic brain injury (TBI) treated in the intensive care unit.

Methods

A post hoc analysis of the erythropoietin in traumatic brain injury (EPO-TBI) trial that included twice-weekly lower limb ultrasound screening. Venous thrombotic events were defined as ultrasound-proven proximal deep venous thrombosis (DVT) or clinically detected pulmonary embolism (PE). Results are reported as events, percentages or medians and interquartile range (IQR). Cox regression analysis was used to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI) for time to VTE and death.

Results

Of 603 patients, 119 (19.7%) developed VTE, mostly comprising DVT (102 patients, 16.9%) with a smaller number of PE events (24 patients, 4.0%). Median time to DVT diagnosis was 6 days (IQR 2–11) and to PE diagnosis 6.5 days (IQR 2–16.5). Mechanical prophylaxis (MP) was used in 91% of patients on day 1, 97% of patients on day 3 and 98% of patients on day 7. Pharmacological prophylaxis was given in 5% of patients on day 1, 30% of patients on day 3 and 57% of patients on day 7. Factors associated with time to VTE were age (HR per year 1.02, 95% CI 1.01–1.03), patient weight (HR per kg 1.01, 95% CI 1–1.02) and TBI severity according to the International Mission for Prognosis and Analysis of Clinical Trials risk of poor outcome (HR per 10% increase 1.12, 95% CI 1.01–1.25). The development of VTE was not associated with mortality (HR 0.92, 95% CI 0.51–1.65).

Conclusions

Despite mechanical and pharmacological prophylaxis, VTE occurs in one out of every five patients with TBI treated in the ICU. Higher age, greater weight and greater severity of TBI increase the risk. The development of VTE was not associated with excess mortality.

Keywords

Erythropoietin Deep venous thrombosis Pulmonary embolism Traumatic brain injury Venous thromboembolism 

Supplementary material

134_2016_4655_MOESM1_ESM.docx (507 kb)
Supplementary material 1 (DOCX 508 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Markus B. Skrifvars
    • 1
    • 2
  • Michael Bailey
    • 1
  • Jeffrey Presneill
    • 1
    • 3
  • Craig French
    • 4
    • 5
  • Alistair Nichol
    • 1
    • 6
    • 7
  • Lorraine Little
    • 1
  • Jacques Duranteau
    • 8
  • Olivier Huet
    • 9
  • Samir Haddad
    • 10
  • Yaseen Arabi
    • 10
  • Colin McArthur
    • 11
  • D. James Cooper
    • 1
    • 7
  • Rinaldo Bellomo
    • 1
    • 12
  • For the EPO-TBI investigators and the ANZICS Clinical Trials Group
  1. 1.Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  2. 2.Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain MedicineHelsinki University and Helsinki University HospitalHelsinkiFinland
  3. 3.Department of Intensive CareRoyal Melbourne HospitalMelbourneAustralia
  4. 4.Department of Intensive CareWestern HealthMelbourneAustralia
  5. 5.University of MelbourneMelbourneAustralia
  6. 6.School of Medicine and Medical SciencesUniversity College DublinDublinIreland
  7. 7.Department of Intensive Care and Hyperbaric MedicineThe AlfredMelbourneAustralia
  8. 8.Département d’Anesthésie-Réanimation, Hôpital de Bicêtre, Assistance Publique des Hopitaux de Paris, Hôpitaux Universitaires Paris-SudUniversité Paris-SudParisFrance
  9. 9.Department of Anaesthesiology and Intensive Care Medicine, CHRU La Cavale BlancheUniversité de Bretagne OccidentaleBrestFrance
  10. 10.King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
  11. 11.Department of Critical Care MedicineAuckland City HospitalAucklandNew Zealand
  12. 12.Department of Intensive CareAustin HealthMelbourneAustralia

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