Venous thromboembolism prophylaxis in operative traumatic brain injury

Venous thromboembolism (VTE) is a significant complication in patients with traumatic brain injury (TBI), but the optimal timing of pharmacological prophylaxis in operative cases remains controversial.

This retrospective study aimed to describe the timing of pharmacological prophylaxis initiation in operative TBI cases, stratified by surgery type, and to report the frequency of worsening postoperative intracranial pathology.

Data from 90 surgical TBI patients were analyzed, revealing that 87.8% received VTE pharmacological prophylaxis at a mean of 85 hours postsurgery. The timing of initiation varied by procedure, with burr holes having the earliest start at a mean of 66 h. Craniotomy and decompressive craniectomy had the longest delay, with means of 116 and 109 h, respectively. Worsening intracranial pathology occurred in 5.6% of patients, with only one case occurring after VTE pharmacological prophylaxis initiation. The overall VTE rate was 3.3%.

These findings suggest that initiating VTE pharmacological prophylaxis between 3 and 5 days postsurgery may be safe in operative TBI patients, with the timing dependent on the procedure's invasiveness. The low frequencies of worsening intracranial pathology and VTE support the safety of these proposed timeframes. However, the study's limitations, including its single-center retrospective nature and lack of a standardized protocol, necessitate further research to confirm these findings and establish evidence-based guidelines for VTE pharmacological prophylaxis in operative TBI patients.