Timing of venous thromboembolic pharmacological prophylaxis in traumatic combined subdural and subarachnoid hemorrhage

Dominik A Jakob,Meghan Lewis,Elizabeth R Benjamin,Delbrynth P Mitchao,Aristomenis K Exadaktylos,Demetrios Demetriades

doi:10.1016/j.amjsurg.2021.11.021

Dominik A Jakob, Meghan Lewis + Show 4 more

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https://doi.org/10.1016/j.amjsurg.2021.11.021

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Abstract

BackgroundThe combination of subdural and subarachnoid hemorrhage is the most common intracranial bleeding. The present study evaluated the timing and type of venous thromboembolic chemoprophylaxis (VTEp) for efficacy and safety in patients with blunt head trauma with combined acute subdural and subarachnoid hemorrhage. MethodsPatients with isolated combined acute subdural and subarachnoid hemorrhage were extracted from the ACS-TQIP database (2013–2017). After 1:1 cohort matching of patients receiving early prophylaxis (EP, ≤48 h) versus late prophylaxis (LP, >48 h) outcomes were compared with univariable and multivariable regression analysis. ResultsMultivariable regression analysis identified EP as an independent protective factor for VTE complications (OR 0.468, CI 0.293–0.748) but not mortality (p = 0.485). The adjusted risk for delayed craniectomy was not associated with EP compared to LP (p = 0.283). The type of VTEp was not associated with VTE complications (p = 0.301), mortality (p = 0.391) or delayed craniectomy (p = 0.126). ConclusionsEarly VTEp (≤48 h) was associated with fewer VTE complications in patients and did not increase the risk for craniectomies in patients with combined acute subdural and subarachnoid hemorrhage.

Highlights

In 2019, a total of 61,000 traumatic brain injury (TBI)-related deaths were recorded in the United States.[1]
The early initiation of pharmacological prophylaxis reduces this risk of venous thromboembolism (VTE), but there is concern it may increase the risk for progression of the intracranial hemorrhage
A 1:1 cohort matching resulted in 2,152 matched cases, which formed the basis of the present study

Summary

Introduction

In 2019, a total of 61,000 traumatic brain injury (TBI)-related deaths were recorded in the United States.[1]. The present study evaluated the timing and type of venous thromboembolic chemoprophylaxis (VTEp) for efficacy and safety in patients with blunt head trauma with combined acute subdural and subarachnoid hemorrhage. Methods: Patients with isolated combined acute subdural and subarachnoid hemorrhage were extracted from the ACS-TQIP database (2013–2017). Results: Multivariable regression analysis identified EP as an independent protective factor for VTE complications (OR 0.468, CI 0.293–0.748) but not mortality (p = 0.485). The adjusted risk for delayed craniectomy was not associated with EP compared to LP (p = 0.283). The type of VTEp was not associated with VTE complications (p = 0.301), mortality (p = 0.391) or delayed craniectomy (p = 0.126). Conclusions: Early VTEp (≤48 h) was associated with fewer VTE complications in patients and did not increase the risk for craniectomies in patients with combined acute subdural and subarachnoid hemorrhage

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