Venous Thromboembolism Risk and Thromboprophylaxis in Pediatric Neurosurgery and Spinal Injury: Current Trends and Literature Review

2021 ◽  
Author(s):  
Dimitrios Panagopoulos ◽  
Ploutarchos Karydakis ◽  
Georgios Noutsos ◽  
Marios Themistocleous
Keyword(s):  
Traumatic Brain Injury ◽  
Venous Thromboembolism ◽  
Brain Injury ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Patient Population ◽  
Pediatric Patients ◽  
Spinal Injury ◽  
Neurosurgical Procedures ◽  
Number Of Patients

AbstractAlthough the entities of venous thromboembolism (VTE), deep venous thrombosis, pulmonary embolus, and thromboprophylaxis in adult patients undergoing brain tumor and spine surgery, traumatic brain injury and elective neurosurgical procedures are widely elucidated, the same is not valid when pediatric patients are under consideration. An attempt to review the peculiarities of these patients through a comprehensive bibliographic review is undertaken. We performed a narrative summary of the relevant literature dedicated to pediatric patients, centered on traumatic brain injury, the general incidence of thromboembolic disease in this patient population, the role of low molecular weight heparin (LMWH) in the treatment and prophylaxis of VTE, and its role in elective neurosurgical procedures, including spinal operations. Additionally, the risk of deep venous thrombosis in elective neurosurgical procedures is reviewed. Due to inherent limitations of the current studies, particularly a restricted number of patients, our data are underpowered to give a definitive protocol and guidelines for all the affected patients. Our current conclusions, based only on pediatric patients, argue that there is limited risk of VTE in pediatric patients suffering from brain tumors and that the possibility of VTE is very low in children undergoing elective neurosurgical procedures. There is no consensus regarding the exact incidence of VTE in traumatic brain injury patients. LMWH seems to be a safe and effective choice for the “at risk” pediatric patient population defined as being older than 15 years, venous catheterization, nonaccidental trauma, increased length of hospital stays, orthopaedic (including spinal) surgery, and cranial surgery.

Evaluation of Heparin Prophylaxis Protocol on Deep Venous Thrombosis and Pulmonary Embolism in Traumatic Brain Injury

2013 ◽  
Vol 79 (10) ◽  
pp. 1050-1053
Author(s):  
Mayin Lin ◽  
Joseph Vivian Davis ◽  
David T. Wong
Keyword(s):  
Traumatic Brain Injury ◽  
Pulmonary Embolism ◽  
Brain Injury ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Clear Trend ◽  
Accepted Standard ◽  
Before And After ◽  
Head Computed Tomography ◽  
Heparin Prophylaxis

There is currently no accepted standard for deep venous thrombosis (DVT) and pulmonary embolism (PE) prophylaxis in patients with traumatic brain injury (TBI). The objective of our study was to evaluate the effects of implementing a subcutaneous heparin prophylaxis protocol for patients with TBI that began in our hospital as of June 2009. In our retrospective cohort study, we examined 3812 TBI records between January 2007 and December 2011. A significant reduction in the risk of DVT/PE development was not demonstrated by comparing DVT and PE incidences before and after protocol implementation. A clear trend between heparin use and DVT occurrence could not be determined from a review of TBI records after June 2009. The use of heparin after initiation of our protocol among operative TBI cases without intracranial hemorrhage (ICH) based on admission head computed tomography was 58 per cent. ICH complication from heparin prophylaxis was 10.6 per cent for patients with TBI with ICH on admission (five of 47 cases) compared with 0.7 per cent for those without ICH on admission (four of 535 cases).

scholarly journals Risk of deep venous thrombosis in elective neurosurgical procedures: a prospective, Doppler ultrasound–based study in children 12 years of age or younger

2017 ◽  
Vol 20 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Andrea G. Scherer ◽  
Ian K. White ◽  
Kashif A. Shaikh ◽  
Jodi L. Smith ◽  
Laurie L. Ackerman ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Doppler Ultrasound ◽  
Pediatric Patients ◽  
Ultrasound Examination ◽  
Neurosurgical Procedures ◽  
Clinical Trial Registration ◽  
Neurosurgical Patients ◽  
Before And After ◽  
Potential Risk Factors

OBJECTIVEThe risk of venous thromboembolism (VTE) from deep venous thrombosis (DVT) is significant in neurosurgical patients. VTE is considered a leading cause of preventable hospital deaths and preventing DVT is a closely monitored quality metric, often tied to accreditation, hospital ratings, and reimbursement. Adult protocols include prophylaxis with anticoagulant medications. Children’s hospitals may adopt adult protocols, although the incidence of DVT and the risk or efficacy of treatment is not well defined. The incidence of DVT in children is likely less than in adults, although there is very little prospectively collected information. Most consider the risk of DVT to be extremely low in children 12 years of age or younger. However, this consideration is based on tradition and retrospective reviews of trauma databases. In this study, the authors prospectively evaluated pediatric patients undergoing a variety of elective neurosurgical procedures and performed Doppler ultrasound studies before and after surgery.METHODSA total of 100 patients were prospectively enrolled in this study. All of the patients were between the ages of 1 month and 12 years and were undergoing elective neurosurgical procedures. The 91 patients who completed the protocol received a bilateral lower-extremity Doppler ultrasound examination within 48 hours prior to surgery. Patients did not receive either medical or mechanical DVT prophylaxis during or after surgery. The ultrasound examination was repeated within 72 hours after surgery. An independent, board-certified radiologist evaluated all sonograms. We prospectively collected data, including potential risk factors, details of surgery, and details of the clinical course. All patients were followed clinically for at least 1 year.RESULTSThere was no clinical or ultrasound evidence of DVT or VTE in any of the 91 patients. There was no clinical evidence of VTE in the 9 patients who did not complete the protocol.CONCLUSIONSIn this prospective study, no DVTs were found in 91 patients evaluated by ultrasound and 9 patients followed clinically. While the study is underpowered to give a definitive incidence, the data suggest that the risk of DVT and VTE is very low in children undergoing elective neurosurgical procedures. Prophylactic protocols designed for adults may not apply to pediatric patients.Clinical trial registration no.: NCT02037607 (clinicaltrials.gov)

Deep Venous Thrombosis Management Following Traumatic Brain Injury

2006 ◽  
Vol 21 (6) ◽  
pp. 483-490 ◽  
Author(s):  
Mary C. Carlile ◽  
Stuart A. Yablon ◽  
W. Jerry Mysiw ◽  
Alan B. Frol ◽  
David Lo ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis

scholarly journals The impact of helmet use on neurosurgical care and outcomes after pediatric all-terrain vehicle and dirt bike crashes: a 10-year single-center experience

2021 ◽  
pp. 1-9
Author(s):  
Jackson H. Allen ◽  
Aaron M. Yengo-Kahn ◽  
Kelly L. Vittetoe ◽  
Amber Greeno ◽  
Muhammad Owais Abdul Ghani ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Absolute Risk ◽  
Skull Fracture ◽  
Pediatric Trauma ◽  
Neurosurgical Procedures ◽  
Intracranial Injury ◽  
Helmet Use ◽  
The Impact

OBJECTIVE All-terrain vehicle (ATV) and dirt bike crashes frequently result in traumatic brain injury. The authors performed a retrospective study to evaluate the role of helmets in the neurosurgical outcomes of pediatric patients involved in ATV and dirt bike crashes who were treated at their institution during the last decade. METHODS The authors analyzed data on all pediatric patients involved in ATV or dirt bike crashes who were evaluated at a single regional level I pediatric trauma center between 2010 and 2019. Patients were excluded if the crash occurred in a competition (n = 70) or if helmet status could not be determined (n = 18). Multivariable logistic regression was used to analyze the association of helmet status with the primary outcomes of 1) neurosurgical consultation, 2) intracranial injury (including skull fracture), and 3) moderate or severe traumatic brain injury (MSTBI) and to control for literature-based, potentially confounding variables. RESULTS In total, 680 patients were included (230 [34%] helmeted patients and 450 [66%] unhelmeted patients). Helmeted patients were more frequently male (81% vs 66%). Drivers were more frequently helmeted (44.3%) than passengers (10.5%, p < 0.001). Head imaging was performed to evaluate 70.9% of unhelmeted patients and 48.3% of helmeted patients (p < 0.001). MSTBI (8.0% vs 1.7%, p = 0.001) and neurosurgical consultation (26.2% vs 9.1%, p < 0.001) were more frequent among unhelmeted patients. Neurosurgical injuries, including intracranial hemorrhage (16% vs 4%, p < 0.001) and skull fracture (18% vs 4%, p < 0.001), were more common in unhelmeted patients. Neurosurgical procedures were required by 2.7% of unhelmeted patients. One helmeted patient (0.4%) required placement of an intracranial pressure monitor, and no other helmeted patients required neurosurgical procedures. After adjustment for age, sex, driver status, vehicle type, and injury mechanism, helmet use significantly reduced the odds of neurosurgical consultation (OR 0.250, 95% CI 0.140–0.447, p < 0.001), intracranial injury (OR 0.172, 95% CI 0.087–0.337, p < 0.001), and MSTBI (OR 0.244, 95% CI 0.079–0.758, p = 0.015). The unadjusted absolute risk reduction provided by helmet use equated to a number-needed-to-helmet of 6 riders to prevent 1 neurosurgical consultation, 4 riders to prevent 1 intracranial injury, and 16 riders to prevent 1 MSTBI. CONCLUSIONS Helmet use remains problematically low among young ATV and dirt bike riders, especially passengers. Expanding helmet use among these children could significantly reduce the rates of intracranial injury and MSTBI, as well as the subsequent need for neurosurgical procedures. Promoting helmet use among recreational ATV and dirt bike riders must remain a priority for neurosurgeons, public health officials, and injury prevention professionals.

scholarly journals AB0687 EFFECT OF COVID-19 ON PATIENTS ATTENDING AMBULATORY DEEP VENOUS THROMBOSIS OUT-PATIENT CLINIC: A RETROSPECTIVE, COHORT ANALYSIS[KI1] [KI1]101 CHARACTERS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1376.2-1377
Author(s):  
T. Hill ◽  
K. P. Iyengar ◽  
A. Nune
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Point Of Care ◽  
Meta Analysis ◽  
Number Of Patients ◽  
Ambulatory Patients ◽  
The Impact

Background:COVID-19 has been acknowledged as an procoagulant disorder with increased risk of venous thromboembolism (VTE) [1]. High rates of VTE in patients admitted to intensive care unit have been reported [2]. However effect of COVID-19 on ambulatory patients attending out-patient clinics has not been described.Objectives:This retrospective, observational cohort study analyses the impact of COVID-19 on incidence of Deep Venous Thrombosis (DVT) in patients referred to Ambulatory Deep Venous Thrombosis Out-patient Clinic (ADOC). A comparative analysis of patients attending ADOC during a similar period in 2019 is undertaken.Methods:Patients who attended the ADOC with suspected DVT during the ‘first wave’ of the COVID-19 pandemic between 01 February and 30 June 2020 at Southport and Ormskirk NHS Trust were studied and compared to a similar period in 2019. Patients characteristics, comorbidities, risk factors, incidence of DVT and relationship with COVID-19 with the evaluation of haematological parameters including D-dimer and two- tier Wells score. Additionally we examined patients outcomes including morbidity, mortality and hospital admissions.Results:Overall, there was a decrease in the number of patients attending the ADOC from 290 in 2019 to 233 in 2020. However, a total of 38 patients tested positive for DVT, a rate of 16.3%, which is compared to an incidence of 7.9% in 2019. Due to evolving protocols, the COVID-19 status of all patients attending the ADOC could not be ascertained. However, 5/233 of the 2020 cohort patients either had a positive test result (n=4) or were symptomatic of COVID-19 (n=1).Conclusion:There has been a 129% increase in the incidence of DVT in patients presenting to ADOC at our trust during the ‘first wave’ of the COVID-19 pandemic. Furthermore, despite fewer patients presenting with DVT symptoms to the ADOC, there appears to be a higher incidence of confirmed DVTs in ambulatory patients during COVID-19.Although there is a strong association inferred between COVID-19 and VTE [3], lack of access to SARS-CoV-2 nasal swab testing of patients attending ADOC for VTE assessment was a limiting factor to establish an association in this study. Because of this, we cannot extrapolate a definite association in patients with mild to moderate COVID-19 illness in the community and DVT.What we postulate is perhaps the higher incidence in the 2020 cohort could be a marker for a mild case of asymptomatic COVID-19 in these patients. Currently there is no guidance as to whether point of care testing should be available in ADOC. We wonder whether a point of care COVID-19 testing of these patients would have positive impact on the rate at which COVID-19 is identified in the community. Furthermore patients have been avoiding hospitals during the pandemic, greater testing should help to reassure and encourage them to seek help earlier during their illness, minimising potential complications such as PE, hospital admission and death.References:[1]Malas MB, Naazie IN, Elsayed N et al. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine. 2020 Dec;29:100639. doi: 10.1016/j.eclinm.2020.100639.]#[2]Helms J, Tacquard C, Severac F et al. CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020 Jun;46(6):1089-1098. doi: 10.1007/s00134-020-06062-x.[3]Di Minno A, Ambrosino P, Calcaterra I, Di Minno MND. COVID-19 and Venous Thromboembolism: A Meta-analysis of Literature Studies. Semin Thromb Hemost. 2020 Sep 3. doi: 10.1055/s-0040-1715456.Disclosure of Interests:None declared

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