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Venous thromboembolic events in critically ill traumatic brain injury patients

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Abstract

Purpose

To estimate the prevalence, risk factors, prophylactic treatment and impact on mortality for venous thromboembolism (VTE) in patients with moderate to severe traumatic brain injury (TBI) treated in the intensive care unit.

Methods

A post hoc analysis of the erythropoietin in traumatic brain injury (EPO-TBI) trial that included twice-weekly lower limb ultrasound screening. Venous thrombotic events were defined as ultrasound-proven proximal deep venous thrombosis (DVT) or clinically detected pulmonary embolism (PE). Results are reported as events, percentages or medians and interquartile range (IQR). Cox regression analysis was used to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI) for time to VTE and death.

Results

Of 603 patients, 119 (19.7%) developed VTE, mostly comprising DVT (102 patients, 16.9%) with a smaller number of PE events (24 patients, 4.0%). Median time to DVT diagnosis was 6 days (IQR 2–11) and to PE diagnosis 6.5 days (IQR 2–16.5). Mechanical prophylaxis (MP) was used in 91% of patients on day 1, 97% of patients on day 3 and 98% of patients on day 7. Pharmacological prophylaxis was given in 5% of patients on day 1, 30% of patients on day 3 and 57% of patients on day 7. Factors associated with time to VTE were age (HR per year 1.02, 95% CI 1.01–1.03), patient weight (HR per kg 1.01, 95% CI 1–1.02) and TBI severity according to the International Mission for Prognosis and Analysis of Clinical Trials risk of poor outcome (HR per 10% increase 1.12, 95% CI 1.01–1.25). The development of VTE was not associated with mortality (HR 0.92, 95% CI 0.51–1.65).

Conclusions

Despite mechanical and pharmacological prophylaxis, VTE occurs in one out of every five patients with TBI treated in the ICU. Higher age, greater weight and greater severity of TBI increase the risk. The development of VTE was not associated with excess mortality.

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Acknowledgements

Markus Skrifvars has received unrestricted grant support from Finska Läkaresällskapet, Medicinska Understödsföreningen Liv och Hälsa and Svenska Kulturfonden.

Author information

Authors and Affiliations

  1. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia

    Markus B. Skrifvars, Michael Bailey, Jeffrey Presneill, Alistair Nichol, Lorraine Little, D. James Cooper & Rinaldo Bellomo

  2. Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland

    Markus B. Skrifvars

  3. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia

    Jeffrey Presneill

  4. Department of Intensive Care, Western Health, Melbourne, VIC, Australia

    Craig French

  5. University of Melbourne, Melbourne, VIC, Australia

    Craig French

  6. School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland

    Alistair Nichol

  7. Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia

    Alistair Nichol & D. James Cooper

  8. Département d’Anesthésie-Réanimation, Hôpital de Bicêtre, Assistance Publique des Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Paris, France

    Jacques Duranteau

  9. Department of Anaesthesiology and Intensive Care Medicine, CHRU La Cavale Blanche, Université de Bretagne Occidentale, Brest, France

    Olivier Huet

  10. King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Samir Haddad & Yaseen Arabi

  11. Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand

    Colin McArthur

  12. Department of Intensive Care, Austin Health, Melbourne, VIC, Australia

    Rinaldo Bellomo

Authors
  1. Markus B. Skrifvars
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  2. Michael Bailey
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  3. Jeffrey Presneill
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  4. Craig French
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  5. Alistair Nichol
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  6. Lorraine Little
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  7. Jacques Duranteau
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  8. Olivier Huet
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  9. Samir Haddad
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  10. Yaseen Arabi
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  11. Colin McArthur
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  12. D. James Cooper
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  13. Rinaldo Bellomo
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Consortia

For the EPO-TBI investigators and the ANZICS Clinical Trials Group

Corresponding author

Correspondence to Markus B. Skrifvars.

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Conflicts of interest

Markus Skrifvars reports having received a research grant from GE Healthcare and travel reimbursements and lecture fees from Orion Pharma, COVIDIEN, Astellas Pharma and Axis-Shield. All other authors report that they have no conflicts of interest.

Additional information

Take-home message: Despite mechanical and pharmacological prophylaxis, venous thromboembolism occurs in one of five patients with traumatic brain injury treated in the intensive care unit. Older age, greater weight and traumatic brain injury severity increase this risk.

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Skrifvars, M.B., Bailey, M., Presneill, J. et al. Venous thromboembolic events in critically ill traumatic brain injury patients. Intensive Care Med 43, 419–428 (2017). https://doi.org/10.1007/s00134-016-4655-2

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  • DOI: https://doi.org/10.1007/s00134-016-4655-2

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