Prophylaxis Against Venous Thromboembolism (VTE) in Patients with Traumatic Brain Injury (TBI)
Research output: Chapter in Book/Report/Conference proceeding › Book chapter
Several recent national guidelines and reviews conclude that pharmacologic, in addition to mechanical thromboprophylaxis, appears to be safe among TBI patients with stabilized hemorrhagic patterns. Despite this, there are many issues concerning efficiency and safety in severe TBI, especially in patients with coagulopathies.
|Research areas and keywords||
Subject classification (UKÄ) – MANDATORY
|Title of host publication||Management of Severe Traumatic Brain Injury|
|Editors||T Sundstrøm, P-O Grände, T Luoto, C Rosenlund, J Undén, KG Wester|
|Place of Publication||Cham, Switzerland|
|Publication status||Published - 2020 Jul 6|
Tips, Tricks, and Pitfalls • Today we have no optimal laboratory technique to monitor various anticoagulants or thromboprophylactic drugs. • There is a thin balance between aggravating TBI haemorrage with too early pharmacologic thromboprophylaxis and increasing risk for thromboembolism by delaying it. • Clinical judgement and evaluation from repetitive CT scans during the first 2–5 (or longer) days is the mainstay. • Calf compression and then starting with low dose LMWH thromboprophylaxis after 2–4 days if the TBI induced haemorrhage seems to be stabilised is recommended by most guidelines. • High alert to stop LMWH if haemorrhage is expanded – protamin can revert some of its effect depending on the anti- Xa/anti-Iia ratio of the specific LMWH. • LMWH should be stopped 12 h before manipulation or withdrawal of intracerebral pressure monitoring/ventricular drainage catheters. • Simultaneous DIC, thrombocytopenia should be resolved/treated before considering LMWH.