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

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 (AIShead 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.

Early Chemical Thromboprophylaxis Does not Increase the Risk of Intracranial Hematoma Progression in Patients with Isolated Severe Traumatic Brain Injury.

BACKGROUND: Venous thromboembolism (VTE) is recognized as a factor of morbidity and mortality in trauma patients suffering from severe blunt traumatic brain injury (TBI). The administration of pharmacological prophylaxis is broadly accepted as an effective therapy to prevent VTE events in trauma patients. Regardless of its ascertained efficacy, the risk of hematoma progression complicates the therapy in patients suffering from TBI: therefore, the optimal time to start prophylactic anticoagulation in these patients remains controversial. METHODS: All primary admissions to our level-1-trauma center between January 2012 and December 2016 were screened for severe blunt TBI with a head Abbreviated Injury Scale (AIS) ≥ 3. Patients who died within the first 24 h were excluded. Basic demographic results, thromboembolic events and progression of the intracranial hematoma were extracted from the patient's records. The patients were categorized into 4 groups according to start of VTE chemoprophylaxis: early ( < 24 h after hospitalization), intermediate (24-48 h), late ( > 48 h) and no therapy (no prophylactic anticoagulation within the first five days of hospitalization). A total of 292 patients with severe TBI were analyzed (early: n = 93, intermediate: n = 90, late: n = 74, no therapy: n = 35). The overall rate of intracranial bleeding progression was 13.6% after prophylactic anticoagulation was started. RESULTS: No statistically significant differences were found in the frequency of intracranial bleeding progression comparing the different time groups (early 12.9% vs. intermediate 11.1% vs. late 17.6%; adj. p = 0.13). In patients with VTE chemoprophylaxis, no thromboembolic events were recorded. Male gender, age, head AIS and subarachnoidal hemorrhage were identified as independent risk factors associated with intracranial hematoma progression. CONCLUSION: The early administration of VTE chemoprophylaxis within 24 h after admission in patients with severe TBI did not increase the risk of intracranial bleeding progression.