Time to prophylaxis linked to VTE incidence in traumatic brain injury patients

Most patients with traumatic brain injury receive delayed prophylaxis, with no association seen between incidence of venous thromboembolism (VTE) and prophylaxis regimen, suggests a study. However, a significant difference is observed in VTE incidence stratified by time to prophylaxis.

In addition, lack of prophylaxis is associated with increased mortality rate, while earlier treatment initiation results in increased minor bleeds.

A team of investigators performed a retrospective review from January 2013 to September 2016 in adults admitted to the intensive care unit with moderate to severe traumatic brain injury to assess VTE prophylaxis for practice variation, efficacy, and safety.

The investigators collected data on demographics, time to stable computerized tomography scan, time to prophylaxis initiation, prophylaxis regimen, and incidences of VTE and adverse effects. They analysed these using descriptive statistics, analysis of variance, and linear regression models.

Ninety-four patients were included in the analysis, of whom 14.6 percent did not receive VTE prophylaxis (G1), 7.3 percent initiated therapy within 0 to 24 hours (G2), 14.6 percent after 24 to 48 hours (G3), and 63.5 percent after 48 hours (G4).

VTE occurred in 0 percent of patients in G1 and G2, 28.6 percent of those in G3, and 8.2 percent of those in G4 (p=0.038). Of the nine cases of VTE, eight received medical and one received trauma prophylaxis dosing (p=0.44). Three major bleeds (p=0.79) and 19 minor ones (p=0.042) occurred.

Fourteen patients died, of whom 42.9 percent were in G1, 0 percent in G2, 14.2 percent in G3, and 42.9 percent in G4 (p=0.009).

“Further studies are required to determine optimal timing of prophylaxis,” the investigators said.

Traumatic brain injury is independently associated with an increased VTE risk. Prophylaxis beyond 48 hours increases VTE risk three- to fourfold, according to the investigators.