In-Hospital Mortality and Hemorrhagic Risks in Traumatic Brain Injury Patients with Early vs. Late Venous...

Area of Science:

• Neuroscience
• Hematology
• Critical Care Medicine

Background:

• Traumatic brain injury (TBI) patients face a high risk of venous thromboembolism (VTE).
• The optimal timing for initiating anticoagulation in hospitalized TBI patients with VTE remains a critical clinical question.

Purpose of the Study:

• To investigate the association between the timing of VTE diagnosis and anticoagulation initiation and in-hospital mortality in TBI patients.
• To identify factors influencing early anticoagulation and assess its impact on hemorrhagic complications and mortality.

Main Methods:

• A retrospective single-center study using data from the University of Texas Trauma Database.
• Patients were stratified by VTE diagnosis timing: early (≤7 days) versus late (>7 days).
• Outcomes included in-hospital mortality, mortality among anticoagulated patients, hemorrhagic complications, and predictors of early anticoagulation.

Main Results:

• In-hospital mortality was similar between early (10%) and late (13%) VTE diagnosis groups (p=0.524).
• Hemorrhagic expansion occurred more frequently in patients diagnosed with early VTE (40% vs. 0%, p=0.046), especially those with subdural hematomas.
• Early anticoagulation was associated with pulmonary embolism (OR=1.86), while severe neurologic injury (GCS <9) was associated with reduced likelihood of early anticoagulation (OR=0.53).

Conclusions:

• In-hospital mortality in TBI patients with VTE is not significantly affected by the timing of diagnosis or anticoagulation initiation.
• Early VTE diagnosis in TBI patients is associated with a higher risk of hemorrhage, underscoring the need for personalized anticoagulation strategies.
• Individualized risk-benefit assessments are crucial for managing VTE in TBI patients to mitigate hemorrhagic risks while preventing thromboembolic events.