Venous thromboembolism prophylaxis in adults with acute traumatic brain injury: a systematic review
Background The optimal timing and type of venous thromboembolism chemoprophylaxis (VTEp) for adults with acute traumatic brain injury (TBI) remains unknown. This systematic review synthesized evidence on the timing and type of VTEp in adults with TBI and highlights evidence gaps.Methods We searched...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-06-01
|
| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/10/2/e001691.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849329108979286016 |
|---|---|
| author | Christopher J Tignanelli Mary Butler Mary L Forte Sallee Brandt Amy Marie Claussen Surbhi Shah |
| author_facet | Christopher J Tignanelli Mary Butler Mary L Forte Sallee Brandt Amy Marie Claussen Surbhi Shah |
| author_sort | Christopher J Tignanelli |
| collection | DOAJ |
| description | Background The optimal timing and type of venous thromboembolism chemoprophylaxis (VTEp) for adults with acute traumatic brain injury (TBI) remains unknown. This systematic review synthesized evidence on the timing and type of VTEp in adults with TBI and highlights evidence gaps.Methods We searched Ovid MEDLINE, Embase, and the Cochrane Library through November 4, 2024 for English language, randomized or non-randomized studies with a comparator that reported VTEp timing or agent in adults with acute TBI, and reported intracranial hemorrhage progression (ICHP), VTE, pulmonary embolism (PE), deep vein thrombosis (DVT), neurosurgical intervention (NSI), adverse events (AEs), length of stay (LOS), function, or mortality. Risk of bias (ROB) was assessed with ROBINS-I as low, moderate, serious, or critical risk in studies that used advanced analytic methods (AAMs) to control selection bias; all other studies were deemed critical risk. We qualitatively synthesized evidence and focused text reporting on studies with AAM.Results From 738 citations, 21 non-randomized studies met criteria (1 moderate, 20 critical ROB): 16 on VTEp timing, 7 on agents. Seven studies used AAM. For VTEp timing (five AAM studies), one study of adults with mostly mild TBI found no significant difference between Early and Late VTEp on ICHP (moderate ROB); no timing studies with AAM reported ICHP for adults with moderate or severe TBI. Findings were mixed for VTE timing on NSI and PE. Early VTEp was associated with fewer DVTs. There was no difference in mortality or serious AEs by VTEp timing. For VTEp agents, three studies with AAM found no significant difference between low molecular weight heparin (LMWH) and unfractionated heparin (UH) on ICHP, PE, DVT, and serious or overall AEs. Results were mixed for LMWH versus UH effects on NSI after VTEp, VTE, LOS and mortality. TBI severity labeling varied across studies and within measures, reducing comparability.Conclusions Clinical evidence on the timing and type of VTEp for adults with acute TBI is of insufficient quality for clinical decision-making. Prospective research designs, standardization of TBI severity labeling, and improved reporting of interventions and outcomes would advance the field.PROSPERO registration number CRD42023421534Level of evidence Systematic Review, Level IV |
| format | Article |
| id | doaj-art-87fed77af8bf429fb49a14e20dd0801d |
| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-87fed77af8bf429fb49a14e20dd0801d2025-08-20T03:47:21ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762025-06-0110210.1136/tsaco-2024-001691Venous thromboembolism prophylaxis in adults with acute traumatic brain injury: a systematic reviewChristopher J Tignanelli0Mary Butler1Mary L Forte2Sallee Brandt3Amy Marie Claussen4Surbhi Shah5Department of Surgery, University of Minnesota System, Minneapolis, Minnesota, USA1Minnesota Evidence-based Practice Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USAUniversity of Minnesota System, Minneapolis, Minnesota, USAUniversity of Minnesota System, Minneapolis, Minnesota, USAUniversity of Minnesota System, Minneapolis, Minnesota, USAMayo Clinic School of Medicine - Scottsdale Campus, Scottsdale, Arizona, USABackground The optimal timing and type of venous thromboembolism chemoprophylaxis (VTEp) for adults with acute traumatic brain injury (TBI) remains unknown. This systematic review synthesized evidence on the timing and type of VTEp in adults with TBI and highlights evidence gaps.Methods We searched Ovid MEDLINE, Embase, and the Cochrane Library through November 4, 2024 for English language, randomized or non-randomized studies with a comparator that reported VTEp timing or agent in adults with acute TBI, and reported intracranial hemorrhage progression (ICHP), VTE, pulmonary embolism (PE), deep vein thrombosis (DVT), neurosurgical intervention (NSI), adverse events (AEs), length of stay (LOS), function, or mortality. Risk of bias (ROB) was assessed with ROBINS-I as low, moderate, serious, or critical risk in studies that used advanced analytic methods (AAMs) to control selection bias; all other studies were deemed critical risk. We qualitatively synthesized evidence and focused text reporting on studies with AAM.Results From 738 citations, 21 non-randomized studies met criteria (1 moderate, 20 critical ROB): 16 on VTEp timing, 7 on agents. Seven studies used AAM. For VTEp timing (five AAM studies), one study of adults with mostly mild TBI found no significant difference between Early and Late VTEp on ICHP (moderate ROB); no timing studies with AAM reported ICHP for adults with moderate or severe TBI. Findings were mixed for VTE timing on NSI and PE. Early VTEp was associated with fewer DVTs. There was no difference in mortality or serious AEs by VTEp timing. For VTEp agents, three studies with AAM found no significant difference between low molecular weight heparin (LMWH) and unfractionated heparin (UH) on ICHP, PE, DVT, and serious or overall AEs. Results were mixed for LMWH versus UH effects on NSI after VTEp, VTE, LOS and mortality. TBI severity labeling varied across studies and within measures, reducing comparability.Conclusions Clinical evidence on the timing and type of VTEp for adults with acute TBI is of insufficient quality for clinical decision-making. Prospective research designs, standardization of TBI severity labeling, and improved reporting of interventions and outcomes would advance the field.PROSPERO registration number CRD42023421534Level of evidence Systematic Review, Level IVhttps://tsaco.bmj.com/content/10/2/e001691.full |
| spellingShingle | Christopher J Tignanelli Mary Butler Mary L Forte Sallee Brandt Amy Marie Claussen Surbhi Shah Venous thromboembolism prophylaxis in adults with acute traumatic brain injury: a systematic review Trauma Surgery & Acute Care Open |
| title | Venous thromboembolism prophylaxis in adults with acute traumatic brain injury: a systematic review |
| title_full | Venous thromboembolism prophylaxis in adults with acute traumatic brain injury: a systematic review |
| title_fullStr | Venous thromboembolism prophylaxis in adults with acute traumatic brain injury: a systematic review |
| title_full_unstemmed | Venous thromboembolism prophylaxis in adults with acute traumatic brain injury: a systematic review |
| title_short | Venous thromboembolism prophylaxis in adults with acute traumatic brain injury: a systematic review |
| title_sort | venous thromboembolism prophylaxis in adults with acute traumatic brain injury a systematic review |
| url | https://tsaco.bmj.com/content/10/2/e001691.full |
| work_keys_str_mv | AT christopherjtignanelli venousthromboembolismprophylaxisinadultswithacutetraumaticbraininjuryasystematicreview AT marybutler venousthromboembolismprophylaxisinadultswithacutetraumaticbraininjuryasystematicreview AT marylforte venousthromboembolismprophylaxisinadultswithacutetraumaticbraininjuryasystematicreview AT salleebrandt venousthromboembolismprophylaxisinadultswithacutetraumaticbraininjuryasystematicreview AT amymarieclaussen venousthromboembolismprophylaxisinadultswithacutetraumaticbraininjuryasystematicreview AT surbhishah venousthromboembolismprophylaxisinadultswithacutetraumaticbraininjuryasystematicreview |