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Venous Thromboembolism Prophylaxis

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Abstract

Venous thromboembolism prophylaxis after traumatic brain injury and spinal cord injury is both necessary and problematic. Here, we discuss the type, dose, and timing of pharmacologic prophylaxis as well as the practice of prophylactic vena cava filtration. The discussions entail brief literature about each practice, the author’s practice patterns, and the recommendations of national organizations.

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References

  1. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994;331:1601–6.

    Article  CAS  PubMed  Google Scholar 

  2. Kahn SR, Shbaklo H, Lamping DL, Holcroft CA, Shrier I, Miron MJ, et al. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost. 2008;6:1105–12.

    Article  CAS  PubMed  Google Scholar 

  3. Geerts WH, Jay RM, Code KI, Chen E, Szalai JP, Saibil EA, et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med. 1996;335:701–7.

    Article  CAS  PubMed  Google Scholar 

  4. Arnold JD, Dart BW, Barker DE, Maxwell RA, Burkholder HC, Mejia VA, et al. Unfractionated heparin three times a day versus enoxaparin in the prevention of deep vein thrombosis in trauma patients. Am Surg. 2010;76:563–70.

    PubMed  Google Scholar 

  5. Kurtoglu M, Yanar H, Bilsel Y, Guloglu R, Kizilirmak S, Buyukkurt D, et al. Venous thromboembolism prophylaxis after head and spinal trauma: Intermittent pneumatic compression devices versus low molecular weight heparin. World J Surg. 2004;28:807–11.

    Article  PubMed  Google Scholar 

  6. Kopelman TR, O’Neill PJ, Pieri PG, Salomone JP, Hall ST, Quan A, et al. Alternative dosing of prophylactic enoxaparin in the trauma patient: is more the answer? Am J Surg. 2013;206:911–6.

    Article  PubMed  Google Scholar 

  7. Cothren CC, Smith WR, Moore EE, Morgan SJ. Utility of once-daily dose of low molecular weight heparin to prevent VTE in multisystem trauma patients. World J Surg. 2007;31:98–104.

    Article  PubMed  Google Scholar 

  8. Bickford A, Majercik S, Bledsoe J, Smith K, Johnston R, Dickerson J, et al. Weight based enoxaparin dosing for venous thromboembolism prophylaxis in the obese trauma patient. Am J Surg. 2013;206:847–51.

    Article  PubMed  Google Scholar 

  9. Norwood SH, Berne JD, Rowe SA, Villareal DH, Ledlie JT. Early venous thromboembolism prophylaxis with enoxaparin in patients with blunt traumatic brain injury. J Trauma. 2008;65:1021–7.

    Article  CAS  PubMed  Google Scholar 

  10. Norwood SH, McAuley CE, Berne JD, Vallina VL, Kerns DB, Grahm TW, et al. A potentially expanded role for enoxaparin in preventing venous thromboembolism in high risk blunt trauma patients. J Am Coll Surg. 2001;192:161–7.

    Article  CAS  PubMed  Google Scholar 

  11. Norwood SH, McAuley CE, Berne JD, Vallina VL, Kerns DB, Grahm TW, et al. Prospective evaluation of the safety of enoxaparin prophylaxis for venous thromboembolism in patients with intracranial hemorrhagic injuries. Arch Surg. 2002;137:696–702.

    Article  CAS  PubMed  Google Scholar 

  12. Phelan HA, Eastman AL, Madden CJ, Aldy K, Berne JD, Norwood SH, et al. TBI risk stratification at presentation: a prospective study of the incidence and timing of radiographic worsening in the Parkland Protocol. J Trauma Acute Care Surg. 2012;73:S122–7.

    Article  PubMed  Google Scholar 

  13. Pastorek RA, Cripps MW, Bernstein IH, Scott WW, Madden CJ, Rickert KL, et al. The modified berne-norwood criteria predict two tiers of risk for TBI progression. J Neurotrauma. 2014;31:1737–43.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Phelan HA, Wolf SE, Norwood SH, Aldy K, Brakenridge SC, Eastman AL, et al. A randomized, double-blinded, placebo-controlled pilot trial of anticoagulation in low-risk TBI: The Delayed vs Early Enoxaparin Prophylaxis I (DEEP I) study. J Trauma Acute Care Surg. 2012;73:1434–41.

    Article  PubMed  Google Scholar 

  15. AbdelFattah KR, Eastman AL, Aldy KN, Wolf SE, Minei JP, Scott WW, et al. A prospective evaluation of the use of routine repeat cranial CT scans in patients with intracranial hemorrhage and GCS Score of 13-15. J Trauma Acute Care Surg. 2012;73:685–8.

    Article  PubMed  Google Scholar 

  16. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed; american college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141:e227S–77S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. The brain trauma foundation guidelines for the management of severe traumatic brain injury: deep vein thrombosis prophylaxis. J Neurotrauma. 2007;24:S32–6.

    PubMed  Google Scholar 

  18. Rogers FB, Cipolle MD, Velmahos G, Rozycki G, Luchette FA. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. J Trauma. 2002;53:142–64.

    Article  PubMed  Google Scholar 

  19. Merli GJ, Crabbe S, Paluzzi RG, Fritz D. Etiology, incidence, and prevention of deep vein thrombosis in acute spinal cord injury. Arch Phys Med Rehabil. 1993;74:1199–205.

    CAS  PubMed  Google Scholar 

  20. Teasell RW, Hsieh JT, Aubut JA, Eng JJ, Krassioukov A, Tu L. For the spinal cord injury rehabilitation evidence review research team. Venous thromboembolism after spinal cord injury. Arch Phys Med Rehabil. 2009;90:232–45.

    Google Scholar 

  21. Chen H, Xiao-Dong W. Heparin for venous thromboembolism prophylaxis in patients with acute spinal cord injury: a systematic review and meta-analysis. Spinal Cord. 2013;51:596–602.

    Article  PubMed  Google Scholar 

  22. Marciniak CM, Kaplan J, Welty L, Chen D. Enoxaparin versus tinzaparin for venous thromboembolic prophylaxis during rehabilitation after spinal cord injury: a retrospective cohort study comparing safety and efficacy. PM and R. 2012;4:11–7.

    Article  PubMed  Google Scholar 

  23. Hebbeler SL, Marciniak CM, Crandall S, Chen D, Nussbaum S, Mendelewski S. Daily vs twice daily enoxaparin in the prevention of venous thromboembolic disorders during rehabilitation following acute spinal cord injury. J Spinal Cord Med. 2004;27:236–40.

    Article  PubMed  Google Scholar 

  24. Chiou-Tan FY, Garza H, Chan KT, Parsons KC, Donovan WH, Robertson CS, et al. Comparison of dalteparin and enoxaparin for deep venous thrombosis prophylaxis in patients with spinal cord injury. Am J Phys Med Rehabil. 2003;82:678–85.

    Article  PubMed  Google Scholar 

  25. Consortium for Spinal Cord Medicine. Early acute management in adults with spinal cord injury: a clinical practice guideline for health care professionals. J Spinal Cord Med. 2008;31:408–79.

    Google Scholar 

  26. Dhall SS, Hadley MN, Aarabi B, Gelb DE, Hurlbert RJ, Rozzelle CJ, et al. Deep venous thrombosis and thromboembolism in patients with cervical spinal cord injuries. Guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 2013;72(Suppl 2):244–54.

    Article  PubMed  Google Scholar 

  27. Greenfield L, Proctor M. Twenty year clinical experience with the Greenfield filter. Cardiovasc Surg. 1995;3:199–205.

    Article  CAS  PubMed  Google Scholar 

  28. PREPIC Study Group. Eight year follow up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 2005;112:416–22.

    Article  Google Scholar 

  29. Phelan HA, Gonzalez RP, Scott WC, White CQ, McClure M, Minei JP. Long-term follow-up of prophylactic permanent vena cava filters in trauma patients. J Trauma. 2009;67:485–9.

    Article  PubMed  Google Scholar 

  30. Brakenridge SC, Henley SS, Kashner TM, Golden RM, Paik DH, Phelan HA, et al. Comparing clinical predictors of deep venous thrombosis vs pulmonary embolus after severe blunt traumatic injury: a new paradigm for post-traumatic VTE? J Trauma Acute Care Surg. 2013;74:1231–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Haut ER, Garcia LJ, Shihab HM, Brotman DJ, Stevens KA, Sharma R, et al. The effectiveness of prophylactic inferior vena cava filters in trauma patients: a systematic review and meta-analysis. JAMA Surg. 2014;149:94–202.

    Article  Google Scholar 

  32. Salottolo K, Offner P, Levy AS, Mains CW, Slone DS, Bar-Or D. Interrupted pharmacologic thromboprophylaxis increases VTE in TBI. J Trauma. 2011;70:19–26.

    Article  CAS  PubMed  Google Scholar 

  33. Louis SG, Van PY, Riha GM, Barton JS, Kunio NR, Underwood SJ, et al. Thromboelastogram-guided enoxaparin dosing does not confer protection from deep vein thrombosis: a randomized controlled pilot trial. J Trauma Acute Care Surg. 2014;76:937–43.

    Article  PubMed  Google Scholar 

  34. Velmahos GC, Petrone P, Chan LS, Hanks SE, Brown CV, Demetriades D. Electrostimulation for the prevention of deep venous thrombosis in patients with major trauma: a prospective randomized study. Surgery. 2005;137:493–8.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. UT Southwestern Medical Center, Parkland Memorial Hospital, Dallas, TX, USA

    Herb A. Phelan

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  1. Herb A. Phelan
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Correspondence to Herb A. Phelan .

Editor information

Editors and Affiliations

  1. Neuroscience Department, Inova Neuroscience Institute Inova Fairfax Medical Campus, Falls Church, Virginia, USA

    James M. Ecklund

  2. Pediatric Neurosciences, Inova Neuroscience Institute, Falls Church, Virginia, USA

    Leon E. Moores

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Phelan, H.A. (2017). Venous Thromboembolism Prophylaxis. In: Ecklund, J., Moores, L. (eds) Neurotrauma Management for the Severely Injured Polytrauma Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-40208-6_22

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  • DOI: https://doi.org/10.1007/978-3-319-40208-6_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40206-2

  • Online ISBN: 978-3-319-40208-6

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