The impact of enoxaparin administration in relationship to hemorrhage in mild traumatic brain injury |
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| Affiliation: | 1. Emory University, Department of Orthopaedics, 59 Executive Park South, Atlanta, GA 30329, United States;2. Emory University, School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, United States;3. Grady Memorial Hospital, 80 Jesse Hill Jr Dr. SE, Atlanta, GA 30303, United States;4. Emory University, Department of Anesthesiology, 1364 Clifton Rd. NE, Atlanta, GA 30322, United States;1. Postgraduate Program in Traumatology and Orthopaedics, Faculty of Medicine-CLAEH University & AEPSM, Montevideo, Uruguay;2. Academic Department of Trauma and Orthopaedic Surgery, University of Leeds, United Kingdom;3. AEPSM, Montevideo, Uruguay;1. Montreal Children’s Hospital, Division of Pediatric General and Thoracic Surgery, Canada;2. McGill University Health Centre, Centre for Global Surgery, Canada;3. McGill University Health Centre, Patient Resource Centre, Canada;1. Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Greece;2. Department of Materials Science and Technology, University of Crete, Heraklion, Greece;3. Institute of Electronic Structure and Laser (IESL), Foundation for Research and Technology Hellas (FORTH), Heraklion, Greece;4. Division of Biostatisctics, School of Medicine, University of Crete, Crete, Greece;5. Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA;6. Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA;1. 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy;2. Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy;1. Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, Leeds, United Kingdom;2. Department of Orthopaedic Surgery, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece;3. NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom |
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| Abstract: | BackgroundVenous thromboembolism prophylaxis in the general trauma population is well established. However, risk of increased intracranial hemorrhage in traumatic brain injury (TBI) population is of concern. The aim for this study is to identify a reproducible model of mild traumatic brain injury (mTBI), evaluated by clinical and histological markers and test the hypothesis that enoxaparin increases the risk of spontaneous brain hemorrhage.Methods40 male Sprague Dawley rats were randomly assigned to 5 groups: group 1 (sham) with no TBI along with 4 groups comparing mTBI with and without pharmacological intervention using enoxaparin at 24 h and 72 h respectively. Mild traumatic brain injury was induced using a weight drop apparatus, with a clinical endpoint of time to right (TTR), along with histological and spectrophotometer analysis for qualitative hemorrhage.ResultsThere is a statistically significant difference between group 1 (sham) and all other groups with a mean longer time to right of 64 s (p = 0.005) in the mTBI groups. There was a statistically significant difference between group 1 (sham) and all other groups with an increase of 6 g/dL hemoglobin (p < 0.001) in the mTBI groups with no difference in hemorrhage between groups that were treated with enoxaparin.ConclusionThe weight drop apparatus is a reproducible model for mTBI that has correlations with clinical and qualitative data. This model was able to produce clinical signs of concussion, as reflected by longer TTR and increased hemoglobin in the mTBI groups. Upon further analysis, there wasno increase in hemorrhage in the pharmacological intervention groups with enoxaparin. |
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| Keywords: | Traumatic brain injury Mild traumatic brain injury Enoxaparin Weight drop apparatus Trauma brain injury |
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