Venous thromboembolic events in traumatic brain injury. Does timing of prophylaxis matter? A single-center retrospective cohort study.

Abstract

Background: Patients with traumatic brain injury (TBI) are at increased risk for venous thromboembolism (VTE) due to immobilization and a hypercoagulable state. The administration and optimal timing for chemoprophylaxis remain unclear because of concerns about safety and efficacy.

Methods: We conducted a retrospective review of adult patients admitted with TBI to a level I trauma center between January 2019 and May 2020. Patient demographics, Glasgow Coma Scale, mobility score, mechanism of injury, comorbidities, timing of chemoprophylaxis and physical therapy, VTE events, and intracranial hemorrhage complications were analyzed. Multivariate logistic regression was performed to identify predictors of VTE.

Results: Among 405 patients, 161 received chemoprophylaxis. Eight patients experienced VTE. Receipt of prophylaxis in ≤48 hours was not associated with reduced VTE risk (P = 0.81). However, a 5-point increase in admission mobility score was independently associated with an 84% lower risk of VTE (P = 0.02). Intracranial hemorrhage expansion occurred in 25 patients, with no significant difference between those who did and did not receive prophylaxis.

Discussion: Higher admission mobility scores predict lower VTE risk in TBI. Early prophylaxis timing was not statistically associated with VTE. These findings underscore the need for prospective studies to determine safe and effective chemoprophylaxis strategies.