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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >A Systematic Review of the Risks and Benefits of Venous Thromboembolism Prophylaxis in Traumatic Brain Injury
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A Systematic Review of the Risks and Benefits of Venous Thromboembolism Prophylaxis in Traumatic Brain Injury

机译：静脉血栓栓塞预防创伤性脑损伤风险和益处的系统审查

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Background: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of pharmacological venous thromboprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the postinjury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. Methods: MEDLINE and EMBASE databases were searched. Inclusion criteria were studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation. Two investigators extracted data and graded the papers’ levels of evidence. Randomized controlled trials were assessed for bias according to the Cochrane Collaboration Tool and Cohort studies were evaluated for bias using the Newcastle-Ottawa Scale. We performed univariate meta-regression analysis in an attempt to identify a relationship between VTEp timing and hemorrhagic progression and assess study heterogeneity using an I 2 statistic. Results: Twenty-one studies were included in the systematic review. Eighteen total studies demonstrated that VTEp postinjury in patients with stable head computed tomography scan does not lead to TBI progression. Fourteen studies demonstrated that VTEp administration 24 to 72 hours postinjury is safe in patients with stable injury. Four studies suggested that administering VTEp within 24 hours of injury in patients with stable TBI does not lead to progressive intracranial hemorrhage. Overall, meta-regression analysis demonstrated that there was no relationship between rate of hemorrhagic progression and VTEp timing. Conclusions: Literature suggests that administering VTEp 24 to 48 hours postinjury may be safe for patients with low-hemorrhagic-risk TBIs and stable injury on repeat imaging.
机译：背景：患有创伤性脑损伤（TBI）的患者正在增加静脉血栓栓塞（VTE）的风险。然而，对药理学静脉缩血基（VTEP）的引发可能导致进一步的颅内出血。我们审查了文献，以确定可以在没有TBI演化和血肿扩张的情况下给药的Postinjury时间间隔。方法：搜索MEDLINE和EMBASE数据库。纳入标准是研究在先前在口服抗凝的TBI患者中调查VTEP的时序和安全性。两位调查人员提取数据并评分论文的证据水平。根据Cochrane协作工具评估随机对照试验，并评估使用纽卡斯尔 - 渥太华规模进行偏见的群组研究。我们进行了单变量的元回归分析，试图识别VTEP定时和出血性进展之间的关系，并使用I 2统计评估研究异质性。结果：二十一项研究纳入系统审查中。总研究表明，VTEP Postinjury稳定的头部计算断层摄影扫描不会导致TBI进展。十四项研究表明，VTEP给药24至72小时Postinjury患者损伤患者是安全的。四项研究表明，在稳定的TBI患者损伤的24小时内施用VTEP不会导致进行性颅内出血。总体而言，元回归分析表明，出血进展率和VTEP时序之间没有关系。结论：文献表明，在止血性危险的患者中，Postinjury施用VTEP 24至48小时，对重复成像进行稳定的损伤可能是安全的。

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