Early Propranolol Is Associated With Lower Risk of Venous Thromboembolism After Traumatic Brain Injury

• Published in: The American surgeon Vol. 87; no. 10; p. 1556
• Main Authors: Dhillon, Navpreet K, Hashim, Yassar M, Conde, Geena, Phillips, George, Fierro, Nicole M, Yong, Felix, Berezin, Naomi, Ley, Eric J
• Format: Journal Article
• Language: English
• Published: United States 01-10-2021
• Subjects: Adult; Aged; Brain Injuries, Traumatic - complications; Female; Humans; Injury Severity Score; Intensive Care Units; Male; Middle Aged; Propranolol - administration & dosage; Retrospective Studies; Vasodilator Agents - administration & dosage; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control; trauma; Deep vein thrombosis; traumatic brain injury; venous thromboembolism; propranolol
• ISSN: 1555-9823
• DOI: 10.1177/00031348211051693

Traumatic brain injury (TBI) results in an elaborate systemic cascade of secondary injury elicited in part by an intrinsic catecholamine response, which ultimately leads to changes in inflammation and coagulopathy. Attenuation of this catecholamine response with agents such as propranolol confers a survival advantage. The related impact of propranolol on venous thromboembolism (VTE) after TBI is largely unknown.
A single institution retrospective review was conducted of all TBI patients requiring intensive care unit (ICU) admission with an injury severity scale (ISS) ≥ 25 from January 2013 to May 2015. Patients who received at least one dose of propranolol within 24 hours of admission (PROP) were compared to patients who did not receive any doses of propranolol (NPROP) during their hospitalization.
Of the 131 patients analyzed, 31 (23.7%) patients received propranolol. The PROP cohort was more severely injured overall (ISS 29 vs 26.5,
.02). While unadjusted VTE rates were similar (16.1% vs 19.0%,
.72), the adjusted VTE rate was lower in the PROP cohort (AOR 0.20 (95% CI 0.04-0.97), adjusted
-value < .05).
Propranolol use in TBI patients who have sustained critical injuries may mitigate the risk of VTE. The mechanism by which this outcome is achieved requires further investigation.