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Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging.

Kim L, Schuster J, Holena DN, Sims CA, Levine J, Pascual JL - J Emerg Trauma Shock (2014)

Bottom Line: Head CT scan Marshall scores were calculated from the initial head CT results.Initial head CT Marshall scores were similar in early and late groups.Possible neuroprotective effects of heparin in humans need further investigation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, USA.

ABSTRACT

Background: Venous thromboembolic prophylaxis (VTEp) is often delayed following traumatic brain injury (TBI), yet animal data suggest that it may reduce cerebral inflammation and improve cognitive recovery. We hypothesized that earlier VTEp initiation in severe TBI patients would result in more rapid neurologic recovery and reduced progression of brain injury on radiologic imaging.

Study design: Medical charts of severe TBI patients admitted to a level 1 trauma center in 2009-2010 were queried for admission Glasgow Coma Scale (GCS), head Abbreviated Injury Scale, Injury Severity Score (ISS), osmotherapy use, emergency neurosurgery, and delay to VTEp initiation. Progression (+1 = better, 0 = no change, -1 = worse) of brain injury on head CTs and neurologic exam (by bedside MD, nurse) was collected from patient charts. Head CT scan Marshall scores were calculated from the initial head CT results.

Results: A total of 22, 34, and 19 patients received VTEp at early (<3 days), intermediate (3-5 days), and late (>5 days) time intervals, respectively. Clinical and radiologic brain injury characteristics on admission were similar among the three groups (P > 0.05), but ISS was greatest in the early group (P < 0.05). Initial head CT Marshall scores were similar in early and late groups. The slowest progression of brain injury on repeated head CT scans was in the early VTEp group up to 10 days after admission.

Conclusion: Early initiation of prophylactic heparin in severe TBI is not associated with deterioration neurologic exam and may result in less progression of injury on brain imaging. Possible neuroprotective effects of heparin in humans need further investigation.

No MeSH data available.


Related in: MedlinePlus

Glasgow coma scale (GCS), head abbreviated Injury Scale (AIS), and head CT Marshall Score at admission to hospital (mean ± SEM, P > 0.05)
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Figure 1: Glasgow coma scale (GCS), head abbreviated Injury Scale (AIS), and head CT Marshall Score at admission to hospital (mean ± SEM, P > 0.05)

Mentions: Clinical (GCS), anatomical (head AIS), and radiological (head CT Marshall score) severity grades at admission did not differ between groups [Table 1 and Figure 1]. However, patients in the early cohort were less globally injured with a significantly lower ISS score than those in either the intermediate or late cohorts (P < 0.05) [Table 1 and Figure 2]. Severity of brain injury upon ED presentation was similar between groups as demonstrated by comparable need for emergent treatment (need for osmotherapy in the ED) and need for immediate neurosurgical intervention (operative craniotomy/craniectomy directly from ED) in all groups [Table 1 and Figure 3]. Twenty-two patients needed emergent craniotomies/craniectomies upon ED presentation. Nonimmediate craniectomies/craniotomies were much less frequent occurring only in four patients (early 2, intermediate 1, and late 1) after ICU admission. Need for ventriculostomy placement and administration of osmotherapy after admission tended to be more frequent in patients receiving early vs. later VTEp, though these differences were not significant [Figure 4]. White blood cell count trends did not significantly differ over the 10-day period [Table 3].


Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging.

Kim L, Schuster J, Holena DN, Sims CA, Levine J, Pascual JL - J Emerg Trauma Shock (2014)

Glasgow coma scale (GCS), head abbreviated Injury Scale (AIS), and head CT Marshall Score at admission to hospital (mean ± SEM, P > 0.05)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126111&req=5

Figure 1: Glasgow coma scale (GCS), head abbreviated Injury Scale (AIS), and head CT Marshall Score at admission to hospital (mean ± SEM, P > 0.05)
Mentions: Clinical (GCS), anatomical (head AIS), and radiological (head CT Marshall score) severity grades at admission did not differ between groups [Table 1 and Figure 1]. However, patients in the early cohort were less globally injured with a significantly lower ISS score than those in either the intermediate or late cohorts (P < 0.05) [Table 1 and Figure 2]. Severity of brain injury upon ED presentation was similar between groups as demonstrated by comparable need for emergent treatment (need for osmotherapy in the ED) and need for immediate neurosurgical intervention (operative craniotomy/craniectomy directly from ED) in all groups [Table 1 and Figure 3]. Twenty-two patients needed emergent craniotomies/craniectomies upon ED presentation. Nonimmediate craniectomies/craniotomies were much less frequent occurring only in four patients (early 2, intermediate 1, and late 1) after ICU admission. Need for ventriculostomy placement and administration of osmotherapy after admission tended to be more frequent in patients receiving early vs. later VTEp, though these differences were not significant [Figure 4]. White blood cell count trends did not significantly differ over the 10-day period [Table 3].

Bottom Line: Head CT scan Marshall scores were calculated from the initial head CT results.Initial head CT Marshall scores were similar in early and late groups.Possible neuroprotective effects of heparin in humans need further investigation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, USA.

ABSTRACT

Background: Venous thromboembolic prophylaxis (VTEp) is often delayed following traumatic brain injury (TBI), yet animal data suggest that it may reduce cerebral inflammation and improve cognitive recovery. We hypothesized that earlier VTEp initiation in severe TBI patients would result in more rapid neurologic recovery and reduced progression of brain injury on radiologic imaging.

Study design: Medical charts of severe TBI patients admitted to a level 1 trauma center in 2009-2010 were queried for admission Glasgow Coma Scale (GCS), head Abbreviated Injury Scale, Injury Severity Score (ISS), osmotherapy use, emergency neurosurgery, and delay to VTEp initiation. Progression (+1 = better, 0 = no change, -1 = worse) of brain injury on head CTs and neurologic exam (by bedside MD, nurse) was collected from patient charts. Head CT scan Marshall scores were calculated from the initial head CT results.

Results: A total of 22, 34, and 19 patients received VTEp at early (<3 days), intermediate (3-5 days), and late (>5 days) time intervals, respectively. Clinical and radiologic brain injury characteristics on admission were similar among the three groups (P > 0.05), but ISS was greatest in the early group (P < 0.05). Initial head CT Marshall scores were similar in early and late groups. The slowest progression of brain injury on repeated head CT scans was in the early VTEp group up to 10 days after admission.

Conclusion: Early initiation of prophylactic heparin in severe TBI is not associated with deterioration neurologic exam and may result in less progression of injury on brain imaging. Possible neuroprotective effects of heparin in humans need further investigation.

No MeSH data available.


Related in: MedlinePlus