Faculty Collaboration Database

Evaluating the efficacy and safety of low-molecular weight heparin as a chemoprophylactic agent in stable traumatic brain injury. Am J Surg 2025 Aug;246:116389

Date

05/17/2025

Pubmed ID

40378495

DOI

10.1016/j.amjsurg.2025.116389

Scopus ID

2-s2.0-105005071571 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: There is a lack of high-quality evidence regarding the most appropriate pharmacologic venous thromboembolism chemoprophylaxis (VTEp) agent in traumatic brain injury (TBI). Low-Molecular Weight Heparin (LMWH) is presumed to reduce VTE events; however, concerns of worsening intracranial hemorrhage (ICH) persist. The aim of the present study is to compare the efficacy and safety of LWMH versus Unfractionated Heparin (UFH) in patients with non-operative TBI.

METHODS: We performed a single-center retrospective review of all adult TBI patients (age ≥18years) admitted to a Level I trauma center (2015-2022). Exclusion criteria included neurosurgical intervention prior to VTEp, absence of VTEp, worsened ICH prior to VTEp initiation, and death or discharge within 48 ​h of admission. The study population was stratified into those who received LMWH versus UFH as VTEp. The primary outcome of interest was VTE events. Secondary outcomes included worsening ICH, transfusion requirements, and in-hospital mortality.

RESULTS: A total of 2176 patients met inclusion criteria (median age 62 years and 64 ​% male) of whom 68 ​% received UFH while 32 ​% received LMWH. Overall, there was no significant difference in demographics, injury characteristics, and time to VTEp initiation; however, compared to patients who received UFH, those who received LMWH were younger (51 vs 68 years p ​< ​0.001) and less likely to present with a subdural hematoma (59 ​% vs 65 ​% p ​= ​0.02). The LMWH cohort had a lower rate of VTE events (1.4 ​% vs 3.0 ​%; p ​= ​0.03) and in-hospital mortality (1.4 ​% vs 3.9 ​%; p ​< ​0.01). No significant differences in worsening ICH (2.8 ​% vs 3.3 ​%; p ​= ​0.2) or transfusion requirements (7.7 ​% vs 8.2 ​%; p ​= ​0.6) were detected. After controlling for age, ISS, BMI, and presence of SDH, LMWH was associated with lower odds of VTE events (AOR: 0.47, 95 %CI: 0.30-0.86) but not mortality (AOR: 0.65, 95%CI: 0.47-1.22).

CONCLUSION: Compared to UFH, LMWH is a safe and effective chemoprophylactic agent in patients with non-operative stable TBI.

LEVEL OF EVIDENCE: Level III, Therapeutic/Care Management.

Author List

Al Tannir AH, Biesboer EA, Tentis M, Golestani S, Dodgion C, Peschman JR, Holena D, Murphy PB, Trevino C, Carver TW, Miranda S, de Moya MA, Puzio T, Schellenberg M, Morris RS

Authors

Thomas W. Carver MD 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
Jacob R. Peschman MD Associate Professor in the Surgery department at Medical College of Wisconsin
Colleen Trevino PhD Assoc Professor Clinical Dir Inpatient 2 in the Surgery department at Medical College of Wisconsin

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

Adult
Aged
Anticoagulants
Brain Injuries, Traumatic
Female
Heparin
Heparin, Low-Molecular-Weight
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Venous Thromboembolism