Venous Thrombus Embolism in Polytrauma: Special Attention to Patients with Traumatic Brain Injury

Deng Chen; Jialiu Luo; Cong Zhang; Liangsheng Tang; Hai Deng; Teding Chang; Huaqiang Xu; Miaobo He; Dongli Wan; Feiyu Zhang; Mengfan Wu; Min Qian; Wen Zhou; Gang Yin; Wenguo Wang; Liming Dong; Zhaohui Tang

doi:10.3390/jcm12051716

Venous Thrombus Embolism in Polytrauma: Special Attention to Patients with Traumatic Brain Injury

J Clin Med. 2023 Feb 21;12(5):1716. doi: 10.3390/jcm12051716.

Authors

Deng Chen¹, Jialiu Luo¹, Cong Zhang¹, Liangsheng Tang¹, Hai Deng¹, Teding Chang¹, Huaqiang Xu², Miaobo He², Dongli Wan², Feiyu Zhang³, Mengfan Wu³, Min Qian⁴, Wen Zhou⁴, Gang Yin³, Wenguo Wang², Liming Dong¹, Zhaohui Tang¹

Affiliations

¹ Department of Trauma Surgery, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
² Intensive Care Unit, Trauma Center, Suizhou Central Hospital, Hubei University of Medicine, Suizhou 441300, China.
³ Department of Trauma Surgery, Trauma Center, Tianmen First People's Hospital, Hubei University of Science and Technology, Tianmen 417300, China.
⁴ Department of Emergency Medicine, The People's Hospital of China Three Gorges University, China Three Gorges University, Yichang 443000, China.

Abstract

Venous thrombus embolism (VTE) is common after polytrauma, both of which are considered significant contributors to poor outcomes and mortality. Traumatic brain injury (TBI) is recognized as an independent risk factor for VTE and one of the most common components of polytraumatic injuries. Few studies have assessed the impact of TBI on the development of VTE in polytrauma patients. This study sought to determine whether TBI further increases the risk for VTE in polytrauma patients. A retrospective, multi-center trial was performed from May 2020 to December 2021. The occurrence of venous thrombosis and pulmonary embolism from injury to 28 days after injury was observed. Of 847 enrolled patients, 220 (26%) developed DVT. The incidence of DVT was 31.9% (122/383) in patients with polytrauma with TBI (PT + TBI group), 22.0% (54/246) in patients with polytrauma without TBI (PT group), and 20.2% (44/218) in patients with isolated TBI (TBI group). Despite similar Glasgow Coma Scale scores, the incidence of DVT in the PT + TBI group was significantly higher than in the TBI group (31.9% vs. 20.2%, p < 0.01). Similarly, despite no difference in Injury Severity Scores between the PT + TBI and PT groups, the DVT rate was significantly higher in the PT + TBI group than in the PT group (31.9% vs. 22.0%, p < 0.01). Delayed anticoagulant therapy, delayed mechanical prophylaxis, older age, and higher D-dimer levels were independent predictive risk factors for DVT occurrence in the PT + TBI group. The incidence of PE within the whole population was 6.9% (59/847). Most patients with PE were in the PT + TBI group (64.4%, 38/59), and the PE rate was significantly higher in the PT + TBI group compared to the PT (p < 0.01) or TBI (p < 0.05) group. In conclusion, this study characterizes polytrauma patients at high risk for VTE occurrence and emphasizes that TBI markedly increases the incidence of DVT and PE in polytrauma patients. Delayed anticoagulant therapy and delayed mechanical prophylaxis were identified as the major risk factors for a higher incidence of VTE in polytrauma patients with TBI.

Keywords: deep venous thrombosis; polytrauma; pulmonary embolism; traumatic brain injury; venous thrombus embolism.

Grants and funding

81873870/National Natural Science Foundation of China