Optimizing venous thromboembolism prophylaxis timing in ventilated traumatic brain injury patients: a retrospective...

Traumatic brain injury (TBI) patients requiring mechanical ventilation face a heightened risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). While early VTE prophylaxis (VTEp) has been shown to reduce thromboembolic complications, the optimal timing remains unclear, particularly in ventilated TBI patients, where concerns about intracranial hemorrhage progression exist. This study evaluates the association between VTEp timing and mechanical ventilation duration in TBI patients.

A retrospective cohort study was conducted using the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) 2017-2021. Adult patients (≥ 15 years) with isolated TBI requiring mechanical ventilation were included. Patients were stratified by Modified Berne-Norwood Criteria (mBNC) into low, moderate, and high-risk categories for hemorrhagic progression. VTEp timing was categorized as very early (≤ 24 h), middle (24-72 h), and late (≥ 72 h). The primary outcome was the duration of mechanical ventilation, analyzed using multivariable linear regression models.

Among 99,078 patients, very early VTEp was associated with a reduction of 3.7 days in ventilator duration and in low and 2.8 days in moderate-risk TBI patients (p < .01). High-risk patients receiving very early prophylaxis exhibited increased mortality (21.3% p < .01).

Very early VTEp (≤ 24 h) was associated with a reduction of 3.7 ventilator days in low-risk and 2.8 days in moderate-risk TBI patients, while high-risk patients demonstrated increased mortality (21.3%). These findings underscore the importance of personalized, risk-stratified prophylaxis strategies. However, given the retrospective design and absence of radiologic progression or cause-specific mortality data, prospective validation is required before implementing practice modifications.

Level III, retrospective/epidemiological.