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Every hour counts: Venous thromboembolism prophylaxis after spinal trauma
Alexandra Campbell1, Michael Rubsamen, Ryan Adkins
1Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana (A.C., M.B., K.S., E.R., D.T., K.H., J.Z., C.M., S.T.); Tulane University School of Public Health, New Orleans, Louisiana (R.A.); Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania (B.S.).
The Journal of Trauma and Acute Care Surgery
|March 20, 2026
Summary
Early venous thromboembolism prophylaxis (VTEp) in spinal trauma patients significantly reduces VTE events and mortality. Delays in initiating VTEp increase the risk of VTE and death in this high-risk group.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Critical Care Medicine
Background:
- Spinal trauma patients face high venous thromboembolism (VTE) risk due to immobility and hypercoagulability.
- Current guidelines suggest VTE prophylaxis (VTEp) initiation between 24-72 hours post-injury, but optimal timing is debated.
- This study focuses on optimal VTEp timing in patients with isolated, blunt spinal trauma (IBST) requiring surgery.
Purpose of the Study:
- To investigate the optimal timing for VTEp administration in surgically managed IBST patients.
- To determine if early VTEp is associated with a reduction in VTE events.
- To assess the relationship between VTEp timing and in-hospital mortality.
Main Methods:
- Observational study using the TQIP database (2018-2022) of patients aged ≥16 with IBST requiring surgery.
- VTEp timing categorized as: no VTEp, early (<24h), intermediate (24-72h), and late (>72h).
- Multivariate logistic regression analyzed VTEp timing's association with VTE events and mortality, adjusting for covariates.
Main Results:
- Of 46,868 IBST patients, 75.5% received pharmacologic VTEp, with 2.6% experiencing VTE and 2.7% mortality.
- Early VTEp (<24h) showed significantly lower odds of VTE compared to intermediate and late VTEp.
- Each hour of delay in VTEp initiation was associated with a 0.2% increase in VTE odds (p<0.001).
Conclusions:
- Preoperative VTEp initiation in operatively managed spinal trauma patients is linked to reduced mortality.
- Delayed VTEp administration increases the risk of both VTE events and mortality.
- Findings support early pharmacologic VTEp for IBST patients to mitigate VTE and mortality risks.
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