For Healthcare Professionals
About TOP TBI
Every year in the UK, an estimated 1.4 million people suffer a Traumatic Brain Injury (TBI) and 200,000 people with TBI are admitted to hospital (1). Following a TBI, patients are at considerable risk of morbidity and mortality for several reasons, including the development of venous thromboembolism (VTE) (2). The most common types of VTE are deep vein thrombosis (DVT) and pulmonary embolism (PE). These problems can complicate recovery from TBI, lead to a longer-term reduction in quality of life and can occasionally be fatal.
Recent systematic reviews have reported a VTE incidence rate following TBI of approximately 10% (3–5). The aetiology of provoked VTE in TBI patients is multifactorial, including prolonged immobility, motor deficits, presence of extracranial injuries, inflammatory cascades, and hyper-coagulability (5–7). The prothrombotic state following traumatic injury has been attributed to many factors, including decreased levels of functional protein C and abnormal antithrombin levels (8).
VTE events are of great clinical concern. TBI patients already face complex recovery from their initial injury, and additional complications, including VTE, have been shown to worsen their outcomes by lengthening hospital stays and reducing their likelihood of being discharged home (9). Therefore, developing effective strategies to prevent VTE in patients with TBI is essential and a priority in this patient group.
In hospitalised patients, national guidelines recommend using mechanical VTE prophylaxis and early
initiation of pharmacological VTE prophylaxis (PTP) for appropriate patient populations (10). In a broad population, this has reduced VTE-related deaths up to 90 days after discharge by 15.4% in the last 12 years (11). However, there are no clear national guidelines on VTE prophylaxis following TBI, including PTP; risk assessment models have not been validated in these patients (12,13). This lack of evidence is also reflected in the Brain Trauma Foundation guidelines (4th edition), stating there is insufficient Level I or II evidence to make recommendations on the timing of PTP in TBI (13). Recent work in patients without TBI suggests a lower bar for prescribing thromboprophylaxis could improve outcomes and make the best use of NHS resources (9,14).
TOP-TBI is a multi-centre, parallel-group, pragmatic, randomised superiority trial to determine the clinical- and cost-effectiveness of early PTP administration versus late administration for adult patients with TBI.
Active sites across the UK
Please view the map below showing all active sites across the UK so you can see whether there is an active GP or hospital site running the TOP TBI trial near you.
How to become a TOP TBI Site?
If, having read the trial information you would like your site to participate in the trial, please complete the “Expression of Interest Form” below.
We will then get in touch with you with the outcome.
Please contact us if you have any questions at: [email protected]
If your site is suitable for activation for the trial, you will be granted access to the Secure Area below. The secure area will provide access to materials to help your site become activated for TOP TBI, as well as other key trial documents and training.
Please follow this link if you would also like to participate within the Associate Principal Investigator Scheme.
