PMID- 21825943
OWN - NLM
STAT- MEDLINE
DCOM- 20111006
LR  - 20220331
IS  - 1529-8809 (Electronic)
IS  - 0022-5282 (Linking)
VI  - 71
IP  - 2
DP  - 2011 Aug
TI  - Safety and efficacy of heparin or enoxaparin prophylaxis in blunt trauma patients 
      with a head abbreviated injury severity score >2.
PG  - 396-9; discussion 399-400
LID - 10.1097/TA.0b013e31822734c9 [doi]
AB  - BACKGROUND: Timing and type of chemoprophylaxis (CP) that should be used in 
      patients with traumatic brain injury (TBI) remains unclear. We reviewed our 
      institutions experience with low-molecular-weight heparin (LMWH) and 
      unfractionated heparin (UFH) in TBI. METHODS: The charts of all TBI patients with 
      a head abbreviated injury severity score >2 (HAIS) and an intensive care unit 
      length of stay >48 hours admitted during a 42-month period between 2006 and 2009 
      were reviewed. CP was initiated after intracranial hemorrhage was considered 
      stable. We reviewed all operative notes and radiologic reports in these patients 
      to analyze the rate of significant intracranial hemorrhagic complications, deep 
      venous thrombosis, or pulmonary embolus. RESULTS: A total of 386 patients with 
      TBI were identified; 158 were treated with LMWH and 171 were treated with UFH. 
      HAIS was significantly different between the LMWH (3.8 +/- 0.7) and UFH (4.1 +/- 0.7) 
      groups; the time to initiation of CP was not. The UFH group had a significantly 
      higher rate of deep venous thrombosis and pulmonary embolus. Progression of ICH 
      that occurred after the initiation of CP was significantly higher in the 
      UFH-treated patients (59%) when compared with those treated with LMWH (40%). Two 
      patients in the UFH group required craniotomy after the initiation of CP. 
      CONCLUSION: LMWH is an effective method of CP in patients with TBI, providing a 
      lower rate of venous thromboembolic and hemorrhagic complications when compared 
      with UFH. A large, prospective, randomized study would better evaluate the safety 
      and efficacy of LMWH in patients suffering blunt traumatic brain injury.
FAU - Minshall, Christian T
AU  - Minshall CT
AD  - Department of Surgery, University of Texas Southwestern/Parkland Memorial 
      Hospital, Dallas, Texas 75390, USA. ctminshall@gmail.com
FAU - Eriksson, Evert A
AU  - Eriksson EA
FAU - Leon, Stuart M
AU  - Leon SM
FAU - Doben, Andrew R
AU  - Doben AR
FAU - McKinzie, Brian P
AU  - McKinzie BP
FAU - Fakhry, Samir M
AU  - Fakhry SM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Trauma
JT  - The Journal of trauma
JID - 0376373
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - *Abbreviated Injury Scale
MH  - Anticoagulants/*therapeutic use
MH  - Brain Injuries/*complications
MH  - Disease Progression
MH  - Enoxaparin/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - *Injury Severity Score
MH  - Length of Stay
MH  - Pulmonary Embolism/etiology/*prevention & control
MH  - Retrospective Studies
MH  - Venous Thrombosis/etiology/*prevention & control
MH  - Wounds, Nonpenetrating/*complications
EDAT- 2011/08/10 06:00
MHDA- 2011/10/07 06:00
CRDT- 2011/08/10 06:00
PHST- 2011/08/10 06:00 [entrez]
PHST- 2011/08/10 06:00 [pubmed]
PHST- 2011/10/07 06:00 [medline]
AID - 00005373-201108000-00019 [pii]
AID - 10.1097/TA.0b013e31822734c9 [doi]
PST - ppublish
SO  - J Trauma. 2011 Aug;71(2):396-9; discussion 399-400. doi: 
      10.1097/TA.0b013e31822734c9.