Effects of Early Chemoprophylaxis in Traumatic Brain Injury and Risk of Venous Thromboembolism

Abstract

Background The optimal timing to initiate venous thromboembolism (VTE) prophylaxis in patients with a traumatic brain injury (TBI) is still unknown. We designed a study to determine the effect that timing of initiation of VTE prophylaxis has on VTE rates in TBI patients. Methods Patient records were obtained from 32 level 1 and 2 trauma centers in the Michigan Trauma Quality Improvement Program from 2008 to 2018. Overall, 5589 patients with a TBI were included and split into cohorts based on VTE prophylaxis initiation time. Outcomes included rate of VTE, mortality, and serious in-hospital complications. Results There were nine patients (1.3%) in the <24 hour group with a VTE as compared to 36 (2.6%) in the 24-48 hour group, 51 (4.1%) in the 48-72 hour group, and 181 (8.1%) in the >72 hour group ( P < .001). The adjusted odds of VTE were significantly greater in patients initiated within 48-72 hours (AOR 2.861, 95% CI 1.271-6.439) and >72 hours (AOR 3.963, 95% CI 1.824-8.612) compared to <24 hours. Patients that received VTE prophylaxis within 24 hours had similar rates of serious in-hospital complication as patients initiated within 24-48 hours (AOR .956, 95% CI .637-1.434) and 48-72 hour (AOR 1.132, 95% CI .757-1.692) but less than the >72 hour group (AOR 1.662, 95% CI 1.154-2.393) groups. Discussion Patients initiated on VTE prophylaxis within 48 hours of presentation had lower incidence of VTE without a significant increase in serious complications.

DVT Prophylaxis in head-injured patients: Current Concepts and Guidelines

“…They showed that early (< 24 hours) administration was not associated with ICH progression 15 . Similar reductions in VTE rates were also observed and reported by Scudday, Saadeh, Rivas, Shulkosky 16,17,18,19 .…”

Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis

“…In a recent study by Shulkosky et al utilizing the TQIP database, authors explored the influence of different VTE prophylaxis initiation timeframes on the incidence of VTE within TBI patients, finding that patients who underwent VTE prophylaxis initiation within the intervals of 48 to 72 hours and beyond 72 hours after admission had higher odds of experiencing VTE occurrences in contrast to patients with administration within the initial 24 hours. 9 Our study supports this evidence, as analysis showed that patients who received late prophylaxis after 24 hours had significantly higher rates of DVT and PE compared to patients who received it early before 24 hours across all racial groups and independent of injury type. While the work by Shulkosky et al showed the benefit of early VTE prophylaxis in reducing VTE incidence within the TBI patient cohort, our investigation highlights that this finding is consistent across racial groups and injury types, additionally underscoring the necessity for individualized strategies that accommodate diverse patient attributes to yield optimized clinical outcomes.…”

“…While the work by Shulkosky et al showed the benefit of early VTE prophylaxis in reducing VTE incidence within the TBI patient cohort, our investigation highlights that this finding is consistent across racial groups and injury types, additionally underscoring the necessity for individualized strategies that accommodate diverse patient attributes to yield optimized clinical outcomes. 9…”

“…While the work by Shulkosky et al showed the benefit of early VTE prophylaxis in reducing VTE incidence within the TBI patient cohort, our investigation highlights that this finding is consistent across racial groups and injury types, additionally underscoring the necessity for individualized strategies that accommodate diverse patient attributes to yield optimized clinical outcomes. 9 This analysis has implications for the administration of VTE prophylaxis in trauma patients. First, we aim for these findings to bring attention to the existence of racial disparities in clinical outcomes, allowing for the tailoring of treatment strategies based on more individual patient factors.…”