In some studies, traumatic brain injury (TBI) is recognized as an independent risk factor of venous thromboembolism (VTE).

OBJECTIVE

To study the features of anticoagulant prevention of VTE in acute period of TBI.

MATERIAL AND METHODS

This retrospective-prospective observational study included 160 patients aged 18-59 years in acute period of isolated TBI. All patients were hospitalized within 48 hours after injury. All patients were assessed using the Glasgow Coma Scale (GCS) and divided into two groups: the 1st group — severe TBI; the 2nd group — mild-to-moderate TBI. We estimated activated partial thromboplastin time, prothrombin index, fibrinogen and platelet count in all patients. In addition, 42 patients underwent rotational thromboelastometry (ROTEM). All hemostatic data were assessed within 7 days after injury.

RESULTS

We observed hypercoagulability (MCF EXTEM >72 mm) after the 4th day in 14.8% of patients with severe TBI and 13.3% of patients with mild-to-moderate TBI. By the 7th day, these changes were revealed in 85.2% of patients with severe TBI and 53.3% of patients with mild-to-moderate TBI. Thanks to ROTEM, we safely realized anticoagulant prevention of VTE in 97.6% of patients (after 3-4 days in patients with severe TBI and 2-3 days in those with mild-to-moderate TBI). Anticoagulant prevention was not carried out in 2.4% of patients. We preferred enoxaparin sodium 40 mg 1-2 times a day (mean frequency 1.56±0.5). Recovery was significantly better in patients who received anticoagulants within 5 days after TBI.

CONCLUSION

The obtained data ensured optimizing the approaches of anticoagulant prevention and reducing the risk of VTE. Moreover, these findings undoubtedly emphasize clinical significance of thromboelastometry in these patients.