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

Abstract

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. 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. There were nine patients (1.3%) in the <24hour group with a VTE as compared to 36 (2.6%) in the 24-48hour group, 51 (4.1%) in the 48-72hour group, and 181 (8.1%) in the >72hour group (P < .001). The adjusted odds of VTE were significantly greater in patients initiated within 48-72hours (AOR 2.861, 95% CI 1.271-6.439) and >72hours (AOR 3.963, 95% CI 1.824-8.612) compared to <24hours. Patients that received VTE prophylaxis within 24hours had similar rates of serious in-hospital complication as patients initiated within 24-48hours (AOR .956, 95% CI .637-1.434) and 48-72hour (AOR 1.132, 95% CI .757-1.692) but less than the >72hour group (AOR 1.662, 95% CI 1.154-2.393) groups. Patients initiated on VTE prophylaxis within 48hours of presentation had lower incidence of VTE without a significant increase in serious complications.