Timing Is Everything: Early Initiation of VTE Prophylaxis Following Major Trauma Is Effective and Safe

To examine the efficacy and safety of the initiation of pharmacologic venous thromboembolism (VTE) prophylaxis within 24 hours of admission for major trauma patients at risk for VTE.

Pharmacologic VTE prophylaxis following major trauma is essential, but there is a fear of bleeding complications. The safety of initiating treatment within 24 hours of admission has not been established.

We examined the efficacy and safety of early initiation of pharmacologic VTE prophylaxis. Patients were stratified by time to initiation [≤24 h (EARLY) or >24 h (LATE)] and compared. VTE, VTE prophylaxis agents, and bleeding complications secondary to VTE prophylaxis were analyzed. A generalized linear mixed model (GLMM) was performed to identify predictors of VTE.

There were 3369 EARLY group patients and 3200 LATE group patients. More patients in the LATE group developed VTE (7.8% vs. 2.8%; P <0.001). Among 345 patients with VTE, deep venous thrombosis (DVT) alone [181 (72%) vs. 61 (65%)], pulmonary embolism (PE) alone [46 (18%) vs. 22 (23%)] and both DVT and PE [24 (10%) vs. 11 (12%)] were present in the LATE compared with the EARLY group. The LATE group had a higher incidence of increased or new intracranial hemorrhage following prophylaxis initiation (0.5% vs. 0.2%; P =0.009) and higher mortality (1.8% vs. 0.6%; P <0.001). GLMM demonstrated that EARLY VTE prophylaxis was associated with a lower risk of VTE [odds ratio (OR): 0.58; 95% CI: 0.44-0.78; P <0.001], after controlling for covariates.

Initiating VTE prophylaxis within the first 24 hours after admission resulted in a 42% reduction of the risk of VTE without increased risk of bleeding and should be regarded as the standard of care, even in traumatic brain injury patients.