Highlights
- •The results of this study support a high incidence of deep vein thrombosis by screening ultrasonography and support performing screening duplex ultrasound on admission to rehabilitation.
- •Risk factors for venous thromboembolism in brain injury include age at injury, body mass index, injury etiology, history of neurosurgical procedure, and surgery during inpatient rehabilitation.
- •Prospective research is needed to confirm these findings and inform clinical practice guidelines.
Abstract
Objective
To determine the incidence of VTE in the population with brain injuries (BIs) using
ultrasonography, and to assess the risk of pulmonary embolism (PE) development and/or
bleeding complications related to anticoagulation.
Design
Retrospective study.
Setting
Acute rehabilitation hospital.
Participants
238 individuals with moderate to severe BI who were routinely screened for VTE with
ultrasonography on admission to rehabilitation (N=238).
Interventions
Not applicable.
Main Outcome Measures
Retrospective chart review was performed to identify individuals who were diagnosed
with VTE at the following 3 time points: in acute care prior to admission to rehabilitation,
at the time of admission diagnosed via screening examination, and after admission
to rehabilitation. Additionally, risk factors for VTE, PE, and incidence of bleeding
complications related to therapeutic anticoagulation were assessed.
Results
123 deep vein thromboses (DVTs) were identified with 38.2% in acute care (n=47), 69.1%
on admission to rehabilitation (n=85), and 7.3% during the course of rehabilitation
stay (n=9). Risk factors for development of VTE included age at injury, body mass
index, injury etiology, history of neurosurgical procedure, and surgery during inpatient
rehabilitation. Of those who were placed on therapeutic anticoagulation due to admission
diagnosis of VTE (n=50), 2% developed recurrent DVT and 2% had bleeding complications.
There was zero incidence of PE.
Conclusion
We demonstrated a high prevalence of VTEs identified on screening ultrasonography
on admission to inpatient rehabilitation among individuals with moderate to severe
BIs, and low complications related to anticoagulation. Given the findings of this
study, prospective research in ultrasonography screening for VTE in moderate to severe
BI is needed.
Keywords
List of abbreviations:
BMI (body mass index), BI (brain injury), CTA (computerized tomography angiography), DVT (deep vein thrombosis), PE (pulmonary embolism), TBI (traumatic brain injury), VP (ventriculoperitoneal)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A randomized, double-blinded, placebo-controlled pilot trial of anticoagulation in low-risk traumatic brain injury: the Delayed Versus Early Enoxaparin Prophylaxis I (DEEP I) study.J Trauma Acute Care Surg. 2012; 73: 1434-1441
- A prospective study of venous thromboembolism after major trauma.N Engl J Med. 1994; 331: 1601-1606
- Early venous thromboembolic event prophylaxis in traumatic brain injury with low-molecular-weight heparin: risks and benefits.J Neurotrauma. 2010; 27: 2165-2172
- Early chemoprophylaxis against venous thromboembolism in patients with traumatic brain injury.Am Surg. 2022; 88: 167-193
- Incidence of venous thromboembolism in patients with traumatic brain injury.Am J Surg. 2007; 193: 380-384
- Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST Practice Management Guidelines Work Group.J Trauma Inj Infect Crit Care. 2002; 53: 142-164
- American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism.Blood Adv. 2020; 4: 4693-4738
- Deep vein thrombosis: prevalence and risk factors in rehabilitation admissions with brain injury.Neurology. 2004; 63: 485-491
- Venous thromboembolic events in critically ill traumatic brain injury patients.Intensive Care Med. 2017; 43: 419-428
- Elevated risk of venous thromboembolism among post-traumatic brain injury patients requiring pharmaceutical immobilization.J Clin Neurosci. 2020; 75: 66-70
- Isolated traumatic brain injury and venous thromboembolism.J Trauma Acute Care Surg. 2014; 77: 238-242
- Intracranial pressure monitors associated with increased venous thromboembolism in severe traumatic brain injury.Eur J Trauma Emerg Surg. 2021; 47: 1483-1490
- The diagnosis of deep vein thrombosis in the multiply injured patient with pelvic ring or acetabular fractures.Orthopedics. 1995; 18: 253-257
- Incidence and risk factors for deep venous thrombosis after moderate and severe brain injury.J Trauma Inj Infect Crit Care. 2010; 68: 912-915
- The risk factors, outcomes, and costs associated with venous thromboembolism after traumatic brain injury: a nationwide analysis.Brain Inj. 2019; 33: 1671-1678
- Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review.Am J Med. 2010; 123: 426-431
- 30-year mortality after venous thromboembolism: a population-based cohort study.Circulation. 2014; 130: 829-836
- Clinical outcome of patients with venous thromboembolism and recent major bleeding: findings from a prospective registry (RIETE): venous thrombosis in patients with recent bleeding.J Thromb Haemost. 2005; 3: 703-709
- Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review.Eur Respir J. 2015; 45: 201-210
- Venous thromboembolism and bleeding in a community setting: the Worcester Venous Thromboembolism Study.Thromb Haemost. 2009; 101: 878-885
- Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery: the VENUS study.J Thromb Haemost. 2007; 5: 1431-1437
- Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury: a prospective observational study and systematic review of the literature.Clin Neurol Neurosurg. 2018; 175: 68-73
- Assessment of the use of pharmacologic venous thromboembolism prophylaxis in post-traumatic brain injury patients.J Pharm Pract. 2021; 34: 864-869
- Asymptomatic deep vein thrombosis is associated with an increased risk of death: insights from the APEX trial.Thromb Haemost. 2018; 118: 2046-2052
- Association between asymptomatic proximal deep vein thrombosis and mortality in acutely ill medical patients.J Am Heart Assoc. 2021; 10e019459
Article info
Publication history
Published online: January 31, 2023
Accepted:
January 5,
2023
Received in revised form:
December 7,
2022
Received:
August 8,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This work was supported by the Craig Hospital Foundation under grant number 2643.
Disclosures: none.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
