Safety of early chemoprophylaxis in traumatic brain injury patients

Patients with traumatic brain injury (TBI) are at elevated risk for forming venous thromboembolism (VTE), warranting initiation of VTE chemoprophylaxis as early as possible, though the timing of initiation is unclear, particularly when intracranial hemorrhage (ICH) is also present. The purpose of this study is to evaluate the safety of early initiation of chemoprophylaxis in the TBI patient population with ICH on initial imaging.

A 2-year retrospective cohort study was conducted on eligible trauma patients admitted to MyMichigan Medical Center Saginaw who sustained ICH and received subcutaneous heparin (SQH) prophylaxis within 24 h of the first stable head computed tomography (CTH). The primary outcome of interest was the change in hemorrhage size on subsequent CTHs following SQH initiation.

63 patients met the inclusion criteria. On the first imaging post-SQ heparin initiation, 26 of the 63 patients (41%) had improved ICH, 37 patients (59%) had stable ICH, and none had worsening ICH.

In TBI patients with ICH, administration of SQH chemoprophylaxis within the first 24 h of stable imaging appears to be safe, without the risk of worsening hemorrhage.