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Semin Thromb Hemost 2022; 48(03): 301-308
DOI: 10.1055/s-0041-1740567
Review Article

Clinical Significance of Vascular Occlusive Events following Moderate-to-Severe Traumatic Brain Injury: An Observational Cohort Study

Alexander Fletcher-Sandersjöö
1   Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
2   Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
,
Charles Tatter
1   Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
2   Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
,
Jonathan Tjerkaski
2   Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
,
Jiri Bartek Jr
1   Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
2   Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
3   Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
,
Mikael Svensson
1   Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
2   Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
,
Eric Peter Thelin   *
2   Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
4   Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
,
Bo-Michael Bellander   *
1   Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
2   Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
› Institutsangaben Funding A.F.-S. acknowledges funding from Region Stockholm (Research Internship). E.P.T. acknowledges funding support from StratNeuro (Karolinska Institutet), he Erling-Persson Family Foundation, Region Stockholm (Clinical Research Appointment), and the Swedish Brain Foundation (#FO2019-0006). The funders had no role in the design or conduct of this research.
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Abstract

Preventing hemorrhage progression is a potential therapeutic opportunity in traumatic brain injury (TBI) management, but its use has been limited by fear of provoking vascular occlusive events (VOEs). However, it is currently unclear whether VOE actually affects outcome in these patients. The aim of this study was to determine incidence, risk factors, and clinical significance of VOE in patients with moderate-to-severe TBI. A retrospective observational cohort study of adults (≥15 years) with moderate-to-severe TBI was performed. The presence of a VOE during hospitalization was noted from hospital charts and radiological reports. Functional outcome, using the Glasgow Outcome Scale (GOS), was assessed at 12 months posttrauma. Univariate and multivariate logistic regressions were used for endpoint assessment. In total, 848 patients were included, with a median admission Glasgow Coma Scale of 7. A VOE was detected in 54 (6.4%) patients, of which cerebral venous thrombosis was the most common (3.2%), followed by pulmonary embolism (1.7%) and deep vein thrombosis (1.3%). Length of ICU stay (p < 0.001), body weight (p = 0.002), and skull fracture (p = 0.004) were independent predictors of VOE. VOE development did not significantly impact 12-month GOS, even after adjusting for potential confounders using propensity score matching. In conclusion, VOE in moderate-to-severe TBI patients was relatively uncommon, and did not affect 12-month GOS. This suggests that the potential benefit of treating bleeding progression might outweigh the risks of VOE.

Keywords

traumatic brain injury - head injury - neurotrauma - vascular occlusive event - pulmonary embolism - deep vein thrombosis - cerebral venous thrombosis

Note

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


Ethical Approval

The study was approved by the Swedish Ethical Review Authority (Dnr: 2019-04476) who waived the need for informed consent.


Authors' Contributions

Study design: A.F.-S. Data collection: A.F-S., C.T., J.T. Statistical analysis: A.F.-S. Data interpretation: All authors. Draft of manuscript: A.F.-S. Critical revision and approval of manuscript: All authors. Study supervision: E.P.T., B.-M.B.


* Shared last authorship.




Publikationsverlauf

Artikel online veröffentlicht:
06. Januar 2022

© 2022. Thieme. All rights reserved.

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