Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy.

IF 2.6 1区 医学
Alhuda Dabbagh, Janine Mielke, Katja S Mühlberg, Karl Titus Hoffmann, Dirk Lindner, Charlotte Huber, Dominik Michalski, Johann Otto Pelz
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引用次数: 0

Abstract

Introduction: Venous thromboembolic events (VTEs) like deep vein thrombosis or pulmonary embolism are frequent complications in (neuro) critical ill patients. Anticoagulation for VTE after space-occupying brain infarction is a therapeutic dilemma. The aim of this retrospective study was to investigate the frequency of clinically apparent VTE in patients with acute ischaemic stroke (AIS) due to large vessel occlusion (LVO), its treatment, and the rate of complications.

Methods: Patients with first AIS due to LVO were assigned to one of the following groups: space-occupying brain infarction with (1) or without (2) decompressive craniectomy (DC), AIS comprising more than 2/3 (3) or less than 2/3 (4) of the middle cerebral artery territory. Clinically obtained parameters included risk factors for VTE, type of thromboprophylaxis, treatment of VTE and treatment-associated complications.

Results: 15 of 173 (8.7%) patients had a VTE, which was diagnosed 10.9 ± 7.2 days after admission. Patients with a space-occupying brain infarction and DC had significantly more VTE (n=11/63; 17.5%) than patients with a space-occupying brain infarction without DC (0/26; p =0.023) or patients without DC (4/110; 3.6%; p = 0.004). Younger age, DC and cumulative duration of central venous catheter were identified as risk factors for VTE. Only three patients had major bleeding events while being anticoagulated (one asymptomatic cerebral and two extracranial bleedings).

Discussion: Patients with space-occupying brain infarction and DC hold a high risk for VTE. Despite extensive infarct size and DC, therapeutic anticoagulation required for VTE appeared to be safe regarding intracranial bleeding complications.

占位性脑梗死和开颅减压术患者静脉血栓栓塞事件的发生频率和治疗。
静脉血栓栓塞事件(vte)如深静脉血栓形成或肺栓塞是(神经)危重症患者常见的并发症。占位性脑梗死后静脉血栓栓塞的抗凝治疗是一个治疗难题。本回顾性研究的目的是探讨由大血管闭塞(LVO)引起的急性缺血性卒中(AIS)患者临床明显静脉血栓栓塞的频率、治疗方法和并发症发生率。方法:将LVO导致的首次AIS患者分为以下两组:占位性脑梗死伴(1)或不伴(2)减压颅骨切除术(DC), AIS占大脑中动脉面积超过2/3(3)或小于2/3(4)。临床获得的参数包括静脉血栓栓塞危险因素、血栓预防类型、静脉血栓栓塞治疗和治疗相关并发症。结果:173例患者中有15例(8.7%)发生静脉血栓栓塞,发生时间为入院后10.9±7.2天。占位性脑梗死和DC患者的VTE明显增加(n=11/63;17.5%)比无DC的占位性脑梗死患者(0/26;p =0.023)或无DC患者(4/110;3.6%;P = 0.004)。年龄小、中心静脉置管时间短、中心静脉置管时间长是静脉血栓栓塞的危险因素。只有3例患者在抗凝治疗期间发生大出血事件(1例无症状脑出血,2例颅外出血)。讨论:占位性脑梗死和DC患者有发生静脉血栓栓塞的高风险。尽管广泛的梗死面积和DC,对于颅内出血并发症,静脉血栓栓塞所需的治疗抗凝治疗似乎是安全的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Investigative Medicine
Journal of Investigative Medicine MEDICINE, GENERAL & INTERNALMEDICINE, RESE-MEDICINE, RESEARCH & EXPERIMENTAL
自引率
0.00%
发文量
111
期刊介绍: Journal of Investigative Medicine (JIM) is the official publication of the American Federation for Medical Research. The journal is peer-reviewed and publishes high-quality original articles and reviews in the areas of basic, clinical, and translational medical research. JIM publishes on all topics and specialty areas that are critical to the conduct of the entire spectrum of biomedical research: from the translation of clinical observations at the bedside, to basic and animal research to clinical research and the implementation of innovative medical care.
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