Traumatic Subdural Hemorrhage – Chemoprophylaxis For VTE.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 10
Abstract
Background: VTE is well known complication of patients with subdural hemorrhage and is well documented in much recent literature with incidence up to 34% in absence of chemoprophylaxis. Objective: To find the efficacy of chemoprophylaxis and factors to affecting VTE within 12 hours of SHD. Methods: This is a Retrospective analysis consisting of patients with subdural hemorrhage presenting to a tertiary care trauma center within 12 hours of injury. These set of patients were compared to another set of matched patients who received Enoxaparin with delayed presentation (24hr to 48 hr). All patients were subjected to CT scan at presentation and base line venous status of lower limbs as per standard trauma protocols. Primary outcome was measured as expanding SDH. Secondary outcome includes craniotomy surgery and mortality. Results: Total 564 patients were included in this study, 188 (33%) received chemoprophylaxis within 12 hr of admission. All patients were equally matched considering all permutations. The primary outcome in early set was in 18%, when compared to delayed set with 17% (p=0.83). Invasive procedure was inevitable in thirty patients in early set (16%) comparing to delayed set, where 70 (19%) were subjected to invasive procedure (p=.38). VTE was detected in 10 (1.7%) patients during their hospitilisation, of which early chemoprophylaxis was given 4 patients (p = 0.75). Mortality rate was similar in both groups. Conclusion: VTE chemoprophylaxis is safe and should be initiated early (<12 hr) in traumatic subdural hemorrhage. Multicentre prospective Meta analytic studies are further required to ensure this protocol.
Authors and Affiliations
Dr. Kotakadira Srinivas, Dr. Aluka Anand Chand
Keywords
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