Venous thromboembolism prophylaxis in patients with traumatic brain injury

Traumatic brain injury (TBI) with associated intracranial hemorrhage (ICH) occurs frequently in trauma. Trauma patients are also at high risk of developing venous thromboembolic (VTE) complications. Low Molecular Weight Heparin (LMWH) is used in trauma patients as prophylaxis to reduce the risk of VTE events. It remains unclear, however, if LMWH is safe to use in trauma patients with ICH for fear of hematoma progression. The "Evidence-based telemedicine: trauma & acute care surgery (EBT-TACS)" Journal Club performed a critical appraisal of 3 recent and most relevant studies on timing to initiate, safety and use of LMWH in trauma patients with ICH. Specifically, we appraised a i) critical literature review on the topic, ii) a multicenter, retrospective cohort study assessing the safety of LMWH in trauma patients with ICH and iii) a randomized, pilot study assessing the feasibility and event rates of ICH progression, laying the groundwork for future randomized controlled trials (RCT) on the topic. Some results are conflicting, with the highest level of evidence being the pilot RCT demonstrating the safety for early use of LMWH in TBI with ICH. Much of this research, however, was generated by a single center and consequently lacks external validity. Furthermore, clinical recommendations cannot be generated based on pilot studies. Evidence-based guidelines and recommendations could not be made at this time, until the completion of further studies on this challenging topic.