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Early prophylaxis reduces risk for PE, DVT in patients with traumatic brain injury
Early initiation of venous thromboembolism prophylaxis appeared associated with decreased risk for pulmonary embolism and deep vein thrombosis in patients with severe traumatic brain injury, according to results of an observational study.
Early initiation of prophylaxis did not confer increased risk for death or late neurosurgical intervention.
“Patients with traumatic brain injury are at elevated risk for developing venous thromboembolism due to prolonged immobilization and systemic hypercoagulability,” James P. Byrne, MD, a general surgery resident and PhD student at University of Toronto, and colleagues wrote. “Deep vein thrombosis frequently complicates the clinical course, and pulmonary embolism is a leading cause of delayed mortality.”
Despite these risks, VTE prophylaxis is “often delayed out of concern for precipitating extension of intracranial hemorrhage,” Byrne and colleagues wrote.
The researchers conducted a propensity-matched cohort study that included 3,634 patients (median age, 43 years; 77% men) with severe traumatic brain injury treated at trauma centers that participated in the American College of Surgeons Trauma Quality Improvement Program between Jan. 1, 2012, and Dec. 31, 2014.
Most were injured either in motor vehicle crashes (23%) or falls (38%). One group (n = 1,546; 43%) received early prophylaxis less than 72 hours after injury; the remaining patients received late prophylaxis at 72 hours or later.
PE occurred in 1.7% of patients, and DVT occurred in 6.5%.
Early prophylaxis appeared associated with lower rates of PE (OR = 0.48; 95% CI, 0.25-0.91) and DVT (OR = 0.51; 95% CI, 0.36-0.72). Byrne and colleagues observed no association between early prophylaxis and late neurosurgical intervention or death.
Craniotomy/craniectomy and intracranial monitor/drain insertion — considered late neurosurgical interventions — were performed in 3.7% of patients. Patients who received late prophylaxis were more likely to undergo early craniotomy/craniectomy (21.5% vs. 16.2%) or intracranial monitor/drain placement (32.4% vs. 27.3%).
Results showed 8.9% of the overall patient population died. Researchers noted that the mortality rate was lower than previous studies of severe traumatic brain injury because the cohort was limited to patients who survived at least 5 days after injury.
“In patients with severe traumatic brain injury, early initiation of pharmacologic VTE prophylaxis (< 72 hours) was associated with significantly lower rates of PE and DVT compared [with] late prophylaxis, with no increased risk [for] late neurosurgical intervention or death. VTE prophylaxis should be initiated early, within 72 hours of hospital arrival, in the context of appropriate patient risk stratification.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.