Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34387
Title: Venous thromboembolism prophylaxis and related outcomes in patients with traumatic brain injury and prolonged intensive care unit stay.
Austin Authors: Park, Seunga;Kalfas, Stefanie;Fazio, Timothy N;Serpa Neto, Ary ;Macisaac, Christopher;Read, David J;Drummond, Katharine J;Bellomo, Rinaldo 
Affiliation: Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.
Health Intelligence Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.;Melbourne Medical School, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.;Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, VIC, Australia.;Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.;Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
Trauma Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.;Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.;Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, VIC, Australia.;Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
Intensive Care
Issue Date: 6-Dec-2021
Date: 2023
Publication information: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine 2021-12-06; 23(4)
Abstract: Objective: Traumatic brain injury (TBI) patients with prolonged intensive care unit (ICU) stay are at risk of secondary intracranial haemorrhage (ICH) and venous thromboembolism (VTE). We aimed to study VTE prophylaxis, secondary ICH, and VTE prevalence and outcomes in this population. Design: Retrospective observational study. Setting: Level 1 trauma centre ICU. Patients: One hundred TBI patients receiving prolonged ICU treatment (≥ 7 days). Interventions: We collected data from medical records, pathology and radiology systems, and hospital and ICU admission databases. We analysed patient characteristics, interventions, episodes and types of secondary ICH and VTE, and timing and dosage of VTE prophylaxis. Results: Data from the 100 patients in our study showed that early use of compression stockings and pneumatic calf compression was common (75% and 91% in the first 3 days, respectively). VTE chemoprophylaxis, however, was only used in 14% of patients by Day 3 and > 50% by Day 10. We observed VTE in 12 patients (10 as pulmonary embolism), essentially all after Day 6. Radiologically confirmed secondary ICH occurred in 43% of patients despite normal coagulation. However, 72% of ICH events (42/58) were radiologically mild, and the median time of onset of ICH was Day 1, when only 3% of patients were on chemical prophylaxis. Moreover, 82% of secondary ICH events (48/58) occurred in the first 3 days, with no severe ICH thereafter. Conclusions: In TBI patients receiving prolonged ICU treatment, early chemical VTE prophylaxis was uncommon. Early secondary ICH was common and mostly radiologically mild, whereas later secondary ICH was essentially absent. In contrast, early VTE was essentially absent, whereas later VTE was relatively common. Earlier chemical VTE prophylaxis and/or ultrasound screening in this population appears logical.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34387
DOI: 10.51893/2021.4.OA1
ORCID: 
Journal: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine
Start page: 364
End page: 373
PubMed URL: 38046690
Type: Journal Article
Appears in Collections:Journal articles

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