Very Early (≤ 24 hours) Venous Thromboembolism Prophylaxis Timing Based on Size and Type of Traumatic Brain Injury: A National Retrospective Analysis of Risk Stratification and Anticoagulation History in the Trauma Population

Abstract

Background

The clinical decision to administer venous thromboembolism prophylaxis (VTE PPX) is determined by an assumption of low rebleeding risk. Findings from this study will inform clinical decisions designed to help traumatic brain injury (TBI) patients avoid VTE complications.

Methods

This retrospective cohort study utilized the ACS-TQIP-PUF from 2017 to 2021. The study population consisted of adult (≥15 years) patients who received LMWH, UFH, or mechanical filter VTE PPX with no missing times and had a blunt isolated TBI. The population was split into two groups, patients with and without a comorbid history of anticoagulation or bleeding disorder (BLEED). The Modified Berne-Norwood Criteria (mBNC) was applied to distinguish each group based on size and TBI type into a low, moderate, and high risk of rebleeding.

Results

A total of 99,078 patients were included in the analysis; 75,952 (76.6%) did not have a comorbid BLEED. A protective effect against mortality, DVT and PE if VTE PPX was given very early in both the low- and moderate-risk groups (all values P < .01). The high-risk group found a higher likelihood of mortality in the very early and mid VTE PPX BLEED group (all values P ≤ .03).

Conclusion

Very early (≤24 hr) VTE PPX in the low- and moderate-risk mBNC reports to be effective in preventing VTE and mortality. Very early VTE PPX in the high-risk group prevents VTE; however, it is associated with a higher likelihood of mortality in BLEED groups.