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Table 11.9 Combination Therapies for the Prevention of Deep Venous Thrombosis post ABI

by | Dec 11, 2018

Table 11.9 Combination Therapies for the Prevention of Deep Venous Thrombosis post ABI

 
Author/ Year/ Country/ Study Design/ N Methods Outcome
Agnelli et al. (1998) USA RCT PEDro=6 N=307 Population: TBI=261, Other=46; Intervention Group (n=153): Mean Age=55.1 yr; Gender: Male=69, Female=84. Placebo Group (n=154): Mean Age=57.5 yr; Gender: Male=84, Female=70. Treatment: Patients received either enoxaparin (40 mg/day) or placebo administered subcutaneously for no less than 7 days, beginning within 24 hr following elective neurosurgery. All patients were fitted with thigh-length compression stockings, which were worn from the morning of surgery until discharge. Outcome Measure: Symptomatic, objectively documented VTE (DVT or PE) or DVT detected by bilateral venography performed at the end of the treatment period.
  1. Eighty-four percent of patients receiving placebo and 85% of the patients receiving enoxaparin had venographic studies sufficient for analysis.
  2. Thirty-two percent of patients in the placebo group and 17% in the intervention group had DVT, with a relative risk of 0.52 (p=0.004).
  3. Six percent of patients in the placebo group had a clinically overt thromboembolic event compared to only 1% in the enoxaparin group.
  4. The rates of proximal DVT were 13% in patients taking placebo and 5% in patients taking enoxaparin (p=0.04).
  5. During the study period, death occurred in 4% and 3% of the placebo and intervention groups, respectively.
Praeger et al. (2012) Australia Cohort N=36 Population: TBI; Mean age=40.3 yr; Gender: Male=28, Female=8; Mean GCS=8. Treatment: Thromboprophylaxis included compression stockings and compression devices, and/or LMWH. Outcome Measure: Rate of DVT and PE assessed with compression ultrasound.
  1. The rate of DVT was 6%, PE was 6%, and total VTE was 11%.
  2. Among individuals with severe TBI the rates of DVT, PE, and total VTE were 10%, 10% and 19%, respectively.
Kurtoglu et al. (2004) Turkey PCT N=120 Population: TBI=103, Other=17; Median Age=37.1 yr; Gender: Male=47, Female=73. Treatment: Patients admitted to the intensive care unit (ICU) were allocated to receive either Intermittent Pneumatic Compression devices (IPC; n=60) placed below the knee or LMWH (n=60) (40 mg/day, enoxaparin sodium) for VTE prophylaxis. Outcome Measure: Rate of DVT, PE and mortality.
  1. In the IPC group, there were 4 (6.6%) and 2 (3.3%) cases of DVT and PE, respectively.
  2. In the LMWH group, there were 3 (5%) and 4 (6.6%) cases of DVT and PE, respectively.
  3. Overall, 7 (11.6%) and 8 (13.3%) patients died in the IPC and the LMWH group, respectively.
  4. There were no significant differences between groups in rates of DVT (p=0.04), PE (p=0.07), or mortality (p=0.08).
PEDro = Physiotherapy Evidence Database rating scale score (Moseley et al., 2002)