An Exploratory Analysis of Chemical and Mechanical VTE Prophylaxis in Patients with High Rebleeding Risk Traumatic...

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Vascular Surgery

Background:

• Limited research exists on venous thromboembolism (VTE) prophylaxis timing in high-risk traumatic brain injury (TBI) patients.
• Previous studies excluded these groups, hindering evidence-based strategies.
• This study addresses the VTE prophylaxis timing gap in high-risk TBI populations.

Purpose of the Study:

• To determine the effect of VTE prophylaxis timing on high rebleeding risk TBI patients.
• To analyze outcomes based on modified Berne Norwood Criteria.
• To inform evidence-based VTE prophylaxis strategies for TBI.

Main Methods:

• Retrospective cohort study using the American College of Surgeons Trauma Quality Program Participant Use File (2017-2022).
• Included adult patients with blunt high rebleeding risk TBI receiving chemical or mechanical prophylaxis.
• Analyzed 12 exposure groups based on VTE prophylaxis timing, assessing ICU stay, ventilation days, and mortality.

Main Results:

• Early chemical VTE prophylaxis (≤24 hours) was linked to shorter ICU stays and reduced ventilation days.
• These benefits were observed regardless of prior anticoagulation or bleeding disorder.
• Inferior vena cava filter placement between 24-72 hours correlated with increased ICU and ventilation duration.

Conclusions:

• Initiating chemical VTE prophylaxis within 24 hours benefits high rebleeding risk TBI patients.
• This timing reduces ICU stays and ventilation days without increasing mortality.
• Inferior vena cava filters may be associated with longer stays due to patient severity, not prophylaxis timing itself.