Faculty Collaboration Database

Early venous thromboembolism chemoprophylaxis in traumatic brain injury requiring neurosurgical intervention: Safe and effective. Surgery 2024 May;175(5):1439-1444

Date

02/23/2024

Pubmed ID

38388229

DOI

10.1016/j.surg.2024.01.026

Scopus ID

2-s2.0-85186220386 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: Traumatic brain injury patients who require neurosurgical intervention are at the highest risk of worsening intracranial hemorrhage. This subgroup of patients has frequently been excluded from prior research regarding the timing of venous thromboembolism chemoprophylaxis. This study aims to assess the efficacy and safety of early venous thromboembolism chemoprophylaxis in patients with traumatic brain injuries requiring neurosurgical interventions.

METHODS: This is a single-center retrospective review (2016-2020) of traumatic brain injury patients requiring neurosurgical intervention admitted to a level I trauma center. Interventions included intracranial pressure monitoring, subdural drain, external ventricular drain, craniotomy, and craniectomy. Exclusion criteria included neurosurgical intervention after chemoprophylaxis initiation, death within 5 days of admission, and absence of chemoprophylaxis. The total population was stratified into Early (≤72 hours of intervention) versus Late (>72 hours after intervention) chemoprophylaxis initiation.

RESULTS: A total of 351 patients met the inclusion criteria, of whom 204 (58%) had early chemoprophylaxis initiation. Overall, there were no significant differences in baseline and admission characteristics between cohorts. The Early chemoprophylaxis cohort had a statistically significant lower venous thromboembolism rate (5% vs 13%, P < .001) with no increased risk of worsening intracranial hemorrhage (10% vs 13%, P = .44) or neurosurgical reintervention (8% vs 10%, P = .7). On subgroup analysis, a total of 169 patients required either a craniotomy or a craniectomy before chemoprophylaxis. The Early chemoprophylaxis cohort had statistically significant lower venous thromboembolism rates (2% vs 11%, P < .001) with no increase in intracranial hemorrhage (8% vs 11%, P = .6) or repeat neurosurgical intervention (8% vs 10%, P = .77).

CONCLUSION: Venous thromboembolism prophylaxis initiation within 72 hours of neurosurgical intervention is safe and effective. Further prospective research is warranted to validate the results of this study.

Author List

Al Tannir AH, Golestani S, Tentis M, Murphy PB, Schramm AT, Peschman J, Dodgion C, Holena D, Miranda S, Carver TW, de Moya MA, Schellenberg M, Morris RS

Authors

Abdul Hafiz Al Tannir MD Postdoctoral Fellow in the Surgery department at Medical College of Wisconsin
Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin
Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin
Daniel N. Holena MD Professor in the Surgery department at Medical College of Wisconsin
Rachel S. Morris MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Jacob R. Peschman MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Andrew T. Schramm PhD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anticoagulants
Brain Injuries, Traumatic
Chemoprevention
Humans
Intracranial Hemorrhages
Retrospective Studies
Venous Thromboembolism