Factors associated with venous thromboembolism in hospitalized traumatic brain injury patients with external...

There are insufficient data to guide the use of venous thromboembolism (VTE) chemical prophylaxis in traumatic brain injury (TBI) patients, leading to substantial variation in practices. We investigated the effectiveness of our institution's protocol-initiating enoxaparin 30 milligrams twice within 72 h of injury-in a cohort of severe TBI patients treated with external ventricular drains (EVD).

A retrospective cohort study of TBI patients from August 2019 to October 2023 was conducted. VTE was defined as pulmonary embolism (PE), lower extremity deep venous thrombosis (DVT), and/or upper extremity DVT. Logistic regression and time-to-event analyses were performed to identify risk factors for in-hospital VTE based on patient demographics, injury characteristics, and chemical prophylaxis data.

We identified 129 TBI patients treated with EVDs. VTE occurred in 26 patients (20.2 %), consisting of isolated DVT in 16, isolated PE in 3, and both PE and DVT in 7. Overall mortality was 30 %, with no mortalities directly attributable to VTE. Obesity was associated with VTE (HR 3.4, 95 % CI 1.5-7.8, p = 0.009). Longer durations of EVD, mechanical ventilation, and intensive care unit (ICU) stays were associated with VTE (all p < 0.001). Other variables including extracranial injury and adherence to chemical prophylaxis were examined but did not reach statistical significance.

Despite most patients receiving enoxaparin prophylaxis within 72 h of injury, VTE events were common in TBI patients treated with EVDs. Strategies including weight-based dosing and earlier initiation merit further consideration, though determining the neurological risks of increased dosing regimens remains a challenge.