DEEP VEIN THROMBOSIS PROPHYLAXIS
LEVEL I AND II
There was insufficient evidence to support a Level I or II recommendation for treatment of deep vein thrombosis (DVT) in severe TBI patients.
Low molecular weight heparin (LMWH) or low-dose unfractioned heparin may be used in combination with mechanical prophylaxis. However, there is an increased risk for expansion of intracranial hemorrhage.
In addition to compression stockings, pharmacologic prophylaxis may be considered if the brain injury is stable and the benefit is considered to outweigh the risk of increased intracranial hemorrhage. There is insufficient evidence to support recommendations regarding the preferred agent, dose, or timing of pharmacologic prophylaxis for deep vein thrombosis.
CHANGES FROM PRIOR EDITION
The Level 3 recommendation supporting use of compression stockings has been incorporated in the recommendation about pharmacologic prophylaxis, as mechanical treatments such as stockings are the general standard of care and there is not a body of evidence or issues that are TBI-specific. DVT pharmacologic prophylaxis is both a topic in general trauma and ICU care and a topic with issues specific to TBI, so the issues specific to TBI are the focus of the recommendations.
Updates will be available athttps://braintrauma.org/coma/guidelines