Assessment of the Use of Pharmacologic Venous Thromboembolism Prophylaxis in Post-Traumatic Brain Injury Patients

Abstract

Background: Traumatic brain injury (TBI) is an independent risk factor for venous thromboembolism (VTE). Prophylaxis (PPX) beyond 48 hours increases VTE risk 3- to 4-fold. Pharmacologic VTE PPX initiation is controversial due to potential bleeding complications. Objective: To evaluate VTE PPX in patients with TBI for practice variation, efficacy, and safety. Methods: Retrospective review from January 2013 to September 2016 in adults admitted to the intensive care unit with moderate to severe TBI. Demographics, time to stable computerized tomography scan, time to PPX initiation, PPX regimen, and incidences of VTE and adverse effects were collected. Data were analyzed via descriptive statistics, analysis of variance, and linear regression models. Results: Of 96 patients included, 14.6% did not receive VTE PPX (G1), 7.3% initiated therapy within 0 to 24 hours (G2), 14.6% after 24 to 48 hours (G3), and 63.5% after 48 hours (G4). VTE occurred in 0% of G1 and G2, 28.6% of G3, and 8.2% of G4 patients ( P = .038). Of 9 VTE cases, 8 received medical and 1 received trauma PPX dosing ( P = .44). There were 3 major bleeds ( P = .79) and 19 minor bleeds ( P = .042). Of 14 fatalities, 42.9% were in G1, 0% in G2, 14.2% in G3, and 42.9% in G4 ( P = .009). Conclusion: The majority of patients received delayed PPX, with no correlation between VTE incidence and PPX regimen. There was a significant difference in VTE incidence stratified by time to PPX. Further studies are required to determine optimal timing of PPX. Higher mortality rate was correlated with the lack of PPX. Increased minor bleeds occurred with earlier PPX initiation.