prophylactic anticoagulation to prevent venous thromboembolism in traumatic intracranial hemorrhage a decision analysis预防性抗凝预防静脉血栓在创伤性颅内出血决策分析.pdfVIP

Scales et al. Critical Care 2010, 14:R72 /content/14/2/R72 R E S E A R C H Open Access Research Prophylactic anticoagulation to prevent venous thromboembolism in traumatic intracranial hemorrhage: a decision analysis 1,2,3 4,5 1 6 1,7 8,9 Damon C Scales* , Jay Riva-Cambrin , Dave Wells , Valerie Athaide , John T Granton and Allan S Detsky Abstract Introduction: Patients with intracranial hemorrhage due to traumatic brain injury are at high risk of developing venous thromboembolism including deep vein thrombosis (DVT) and pulmonary embolism (P E). Thus, there is a trade- off between the risks of progression of intracranial hemorrhage (ICH) versus reduction of DVT/PE with the use of prophylactic anticoagulation. Using decision analysis modeling techniques, we developed a model for examining this trade-off for trauma patients with documented ICH. Methods: The decision node involved the choice to administer or to withhold low molecular weight heparin (LMWH) anticoagulation prophylaxis at 24 hours. Advantages of withholding therapy were decreased risk of ICH progression (death, disabling neurologic deficit, non-disabling neurologic deficit), and decreased risk of systemic bleeding complications (death, massive bleed). The associated disadvantage was greater risk of developing DVT/PE or death. Probabilities for each outcome were derived from natural history studies and randomized controlled trials when available. Utilities were obtained from accepted databases and previous studies. Results: The expected value associated with withholding anticoagulation prophylaxis was similar (0.90) to that associated with the LMWH strategy (0.89). Only two threshold values were encounte