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Updated: Jan 12, 2026
Author Spotlight: Deciphering Coagulation Disorders in Traumatic Brain Injury Patients
Published on: August 4, 2023
Venous thromboembolism in traumatic brain injury patients despite aggressive early chemoprophylaxis
Jan-Michael Van Gent1, Keith W Burczak1, Devi A Bavishi1
1University of Texas Health Science Center at Houston - Department of Surgery, Division of Acute Care Surgery, Red Duke Trauma Institute, The McGovern School of Medicine, United States.
Background:
Venous thromboembolism (VTE) remains a serious complication after traumatic brain injury (TBI). This study examined the incidence and risk factors for VTE despite early, protocolized chemoprophylaxis (CP) with anti-Xa-based escalation.
Methods:
Retrospective cohort of adult polytrauma patients with TBI (9/16-12/21). Patients developing clinically significant deep vein thrombosis (DVT) or pulmonary embolism (PE) were compared to those without. Multivariable frequentist and Bayesian regression identified predictors of VTE.
Results:
Of 1554 patients, 54 (3.5 %) developed VTE (DVT 1.5 %, PE 1.5 %, both 0.5 %). Patients with VTE had higher injury severity (ISS 34 vs 27), lower GCS (3 vs 12), and greater base deficit. Mean time to prophylaxis was similar (56 vs 44 h). Heparin CP, enoxaparin dose escalation, and increased base deficit independently predicted VTE.
Conclusions:
Despite early CP, VTE occurred in 3.5 % of patients. Enoxaparin remains standard; future efforts should minimize sub-prophylactic anti-Xa levels.
Level Of Evidence:
Level III, prognostic/epidemiological.
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