Early start of thromboprophylaxis does not increase risk of intracranial hematoma progression in multiply injured patients with traumatic brain injury

ABSTRACT

Background

Venous thromboembolism (VTE) in severely injured patients with severe traumatic brain injury (TBI) is a risk during the clinical course. Data on the safety of an early initiation of pharmacological VTE prophylaxis in severely injured patients with concomitant severe TBI is sparse.

Methods

Admissions to our level-1-trauma center between January 2015 and December 2018 were screened. Patients suffering from severe TBI (Abbreviated Injury Scale (AIS) of the head ≥3) and at least one further AIS ≥ 3 in any other body region were included. Demographic data, thromboembolic events, and progression of the intracranial hemorrhage were extracted from the patient’s charts. According to the first application of pharmacological thromboprophylaxis (VTEp), patients were categorized either to the early, the late (later than 24 h) or the no therapy group.

Results

In 79 patients (early: n = 35, late: n = 29, no therapy: n = 15) the Injury Severity Score (ISS) was 36.7 ± 12.7 points (AIS_head 4.1 ± 0.8). No differences were found regarding the progression of the intracranial hemorrhage after initiation of the VTE prophylaxis (adj. p = 0.8). The VTE rate was low (n = 1, 1.6%).

Conclusion

In severely injured patients with severe TBI, the early administration of pharmacological thromboprophylaxis did not result in a higher rate of intracranial hematoma progression.

KEYWORDS:

• Traumatic brain injury
• chemoprophylaxis
• thromboembolism
• multiple trauma

Abbreviations

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Disclosure statement

No potential conflict of interest was reported by the authors.

Authors’ contributions

Conceptualization: P.S., and T.L., methodology: P.S., T.L., and I.M., validation and formal analysis: P.S., and T.L., resources: I.M., investigation and collection of data: W.O., C.R.S., and R.D.V., original draft preparation P.S., and T.L., review and editing: I.M., and R.D.V. All authors read and approved the final manuscript.

Ethics approval

This study was approved by the local Committee for Ethics (EV 496/16) of the Johann-Wolfgang Goethe University.

Data availability statement

The datasets used during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.