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Patients with traumatic brain injury and resultant intracranial hemorrhage (ICH) are at high risk for developing venous thromboembolism (VTE). The use of thromboprophylaxis is effective at decreasing the rate of VTE, but at the potential expense of an increased risk of ICH progression. Physicians must carefully consider both the benefits and risks of VTE prophylaxis before prescribing chemical anticoagulants to these patients. To help clarify this difficult choice, Scales and colleagues performed a decision analysis to determine whether the benefits of thromboprophylaxis outweigh the potential risk of worsening ICH. There is increasing evidence that bleeding risks are not as prominent as previously thought. Although the results were largely inconclusive, the present study has identified areas for future research.

Stress ulcers are characterized by difficult management and poor prognosis. They currently represent a complication in the clinical course of other conditions, mainly shock states. The pathogenesis of stress ulcers is not well understood although the role of hypovolemia leading to energetic deprivation and insaturation of anaerobic cellular metabolism have been carefully studied. Somatostatin has been found to reduce the incidence of experimental stress ulcers. In the clinic, patients with duodenal ulcers were found to exhibit a low number of antral D cells and a significant decrease in tissue somatostatin. In a multicenter trial, patients with bleeding peptic or stress ulcers were treated with somatostatin or cimetidine plus pirenzepine. Results were favorable to the former substance on account of the time required to stop the hemorrhage and the demands for blood replacement. Thus, medical management of bleeding ulcers with somatostatin may represent an alternative to more radical surgical intervention.