C. P. Mamikunian1, J. Bardes1, L. Dudas1, A. Wilson1 1West Virginia University, Surgery, Morgantown, WV, USA
Introduction:
The modern trauma team must balance the risk of recurrent or worsening bleeding with the threat of developing thromboembolism. A growing body of research suggests the widespread overutilization of repeat imaging of patients with traumatic brain injury(TBI). In this context, we aim to understand the effects of DVT prophylaxis(ppx) on TBI and determine if routine CT imaging after starting these medications is useful in the detection of significant expansion of these bleeds.
Methods:
This is a retrospective study of adult patients with isolated TBI who were cared for at a single level one trauma institution over a 5 year period. Our institution has routinely started DVT ppx 48 hours after TBI and repeated a head CT 12 hours after administration of the first dose of DVT ppx. Our primary outcomes of interest are the detection of clinically significant expansions of head bleeds, and the need for neurosurgery intervention (ie craniotomy or invasive monitoring device).
Results:
During this research period, 313 patients met inclusion criteria, 13 (4%) of which demonstrated radiographic expansion on follow-up CT scan after starting DVT ppx. There were two (<1%) instances of a clinical change in a patient possibly signifying expansion of head bleed, but neither required neurosurgical intervention. The most frequent intervention was another head CT after the 1st CT showed small bleed expansions- all of which were stable
Conclusion:
Our findings indicate the routine use of repeat Head CT after DVT ppx administration is unnecessary, and did not have utility in detecting clinically significant expansion of head bleeds. Our findings also suggest DVT ppx in TBI patients is generally safe and should be initiated as soon as possible, considering the overall burden of injury and individual patient characteristics. Further inquiry should be pursued as to the optimal timing of DVT ppx and, if indicated, therapeutic anti-coagulation in TBI patients.
