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Published on: March 26, 2019
Early VTE prophylaxis in severe traumatic brain injury: A propensity score weighted EAST multicenter study
Asanthi M Ratnasekera1, Daniel Kim, Sirivan S Seng
1From the Division of Trauma and Surgical Critical Care, Department of Surgery (A.M.R.), Drexel College of Medicine, Philadelphia; Department of Surgery (D.K., S.S.S.), Crozer Health, Upland; Department of Surgery (C.J., E.J.K.), University of Pennsylvania, Philadelphia PA, Pennsylvania; Department of Surgery (H.M.S., M.B.A.), Virginia Commonwealth University, Richmond, Virginia; Department of Surgery (L.L.P.), Penn Medicine Lancaster General Health, Lancaster; Department of Surgery (C.M.), Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania; Department of Surgery (I.S.), Surgical Intensive Care Unit, New York Medical College, Department of Surgery (A.J.), West Chester Medical Center, Valhalla, New York; Department of Surgery (V.S., A.M.), St. Joseph Mercy Ann Arbor, Ypsilanti, Michigan; Department of Surgery (E.T., M.R.), Loma Linda University Medical Center, Loma Linda, California; Department of Surgery (L.L., W.Z.), St. Mary's Medical Center, West Palm Beach; Florida Atlantic University (L.L., W.Z.), Boca Raton, Florida; Department of Surgery (A.K., M.H.), Trinity Health Oakland, Pontiac, Michigan; Department of Surgery (J.C., C.B.), Prisma Health Upstate, Greenville, South Carolina; Department of Surgery (T.E., A.M.), Cooper University Hospital, Camden New Jersey; Department of Surgery (M.K., S.D.), Ohio Health Grant Medical Center, Columbus; Department of Surgery (R.C.), Department of Research (S.S.), Promedica Toledo Hospital, Toledo Ohio; Department of Surgery (L.E.J., J.W.), Ascension St. Vincent Hospital, Indianapolis, Indiana; Department of Trauma and Acute Care Surgery (M.W., B.P.), Kettering Health Main Campus, Kettering Ohio; Department of Surgery (C.M., N.T.), Spartanburg Medical Center, Spartanburg South Carolina; Department of Surgery (T.H., T.D.), Memorial Healthcare System, Hollywood, Florida; Department of Surgery (S.M.), Conemaugh Memorial Medical Center, Johnstown, Pennsylvania; Department of Surgery (L.D.-S., A.R.), University Hospitals Cleveland Medical Center, Cleveland, Ohio; Department of Surgery (L.C.T., T.J.N.), Cook County Hospital, Chicago, Illinois; Department of Surgery (D.H., D.R.), Penrose Hospital, Colorado Springs, Colorado; Department of Surgery (D.C.C., C.F.), Maine Medical Center, Portland, Maine; Department of Surgery (M.M., C.D.), St. Anthony Hospital, Lakewood, Colorado; Department of Surgery (J.D., S.B.), University of California, San Francisco-Fresno, San Francisco, California; Department of Surgery (K.S.), Yale School of Medicine, New Haven, Connecticut; Department of Surgery (P.F.), INOVA Fairfax Health System, Fairfax, Virginia.
Background:
Patients with traumatic brain injury (TBI) are at high risk of venous thromboembolism events (VTE). We hypothesized that early chemical VTE prophylaxis initiation (≤24 hours of a stable head CT) in severe TBI would reduce VTE without increasing risk of intracranial hemorrhage expansion (ICHE).
Methods:
A retrospective review of adult patients 18 years or older with isolated severe TBI (Abbreviated Injury Scale score, ≥ 3) who were admitted to 24 Level I and Level II trauma centers from January 1, 2014 to December 31 2020 was conducted. Patients were divided into those who did not receive any VTE prophylaxis (NO VTEP), who received VTE prophylaxis ≤24 hours after stable head CT (VTEP ≤24) and who received VTE prophylaxis >24 hours after stable head CT (VTEP>24). Primary outcomes were VTE and ICHE. Covariate balancing propensity score weighting was utilized to balance demographic and clinical characteristics across three groups. Weighted univariate logistic regression models were estimated for VTE and ICHE with patient group as predictor of interest.
Results:
Of 3,936 patients, 1,784 met inclusion criteria. Incidences of VTE was significantly higher in the VTEP>24 group, with higher incidences of DVT in the group. Higher incidences of ICHE were observed in the VTEP≤24 and VTEP>24 groups. After propensity score weighting, there was a higher risk of VTE in patients in VTEP >24 compared with those in VTEP≤24 (odds ratio, 1.51; 95% confidence interval, 0.69-3.30; p = 0.307), however was not significant. Although, the No VTEP group had decreased odds of having ICHE compared with VTEP≤24 (odds ratio, 0.75; 95% confidence interval, 0.55-1.02, p = 0.070), the result was not statistically significant.
Conclusion:
In this large multi-center analysis, there were no significant differences in VTE based on timing of initiation of VTE prophylaxis. Patients who never received VTE prophylaxis had decreased odds of ICHE. Further evaluation of VTE prophylaxis in larger randomized studies will be necessary for definitive conclusions.
Level Of Evidence:
Therapeutic Care Management; Level III.
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