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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

Radiological progression of intracranial lesion as described in serial head CTs by attending neuroradiologists. Positive deflection implies improvement, negative deflection implies worsening. For each patient at each time interval, radiology records were queried for change in neurological exam and a score of +1 (improvement), 0 (no change/no scan done during this time frame) or −1 (worsening) were averaged for the group (mean ± SEM, *P < 0.05 early vs. late)
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Figure 6: Radiological progression of intracranial lesion as described in serial head CTs by attending neuroradiologists. Positive deflection implies improvement, negative deflection implies worsening. For each patient at each time interval, radiology records were queried for change in neurological exam and a score of +1 (improvement), 0 (no change/no scan done during this time frame) or −1 (worsening) were averaged for the group (mean ± SEM, *P < 0.05 early vs. late)

Mentions: In all three groups, head CTs demonstrated worsening of the injury during the first 24 h. Thereafter, scans tended to stabilize and finally demonstrate signs of resolution in all groups. The slowest progression of radiologic brain injury occurred in the early group, which was significantly slower than in the late group in hours 8-48 postadmission (P < 0.05) [Figure 6].


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)

Radiological progression of intracranial lesion as described in serial head CTs by attending neuroradiologists. Positive deflection implies improvement, negative deflection implies worsening. For each patient at each time interval, radiology records were queried for change in neurological exam and a score of +1 (improvement), 0 (no change/no scan done during this time frame) or −1 (worsening) were averaged for the group (mean ± SEM, *P < 0.05 early vs. late)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Radiological progression of intracranial lesion as described in serial head CTs by attending neuroradiologists. Positive deflection implies improvement, negative deflection implies worsening. For each patient at each time interval, radiology records were queried for change in neurological exam and a score of +1 (improvement), 0 (no change/no scan done during this time frame) or −1 (worsening) were averaged for the group (mean ± SEM, *P < 0.05 early vs. late)
Mentions: In all three groups, head CTs demonstrated worsening of the injury during the first 24 h. Thereafter, scans tended to stabilize and finally demonstrate signs of resolution in all groups. The slowest progression of radiologic brain injury occurred in the early group, which was significantly slower than in the late group in hours 8-48 postadmission (P < 0.05) [Figure 6].

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