Venous Thromboembolism Prophylaxis in Neurosurgical Trauma Patients

Background Venous thromboembolisms (VTEs) occur more frequently in patients with traumatic brain injuries (TBIs) and spinal cord injuries, yet the use of chemoprophylaxis is controversial. The purpose of this study was to investigate the relationship between the timing of chemical VTE prophylaxis initiation and the development of VTE events in these patients. Methods Prospective data were collected and retrospectively reviewed on 1,425 patients sustaining TBIs or spinal injuries from 2010 to 2014. Patients were reviewed with respect to age, gender, injury severity score (ISS), Glasgow coma score (GCS), and mechanism of injury as well as timing of initiation of chemical VTE prophylaxis and presence or absence of VTE. Results Patients who developed a VTE had a significantly longer time to initiation of chemical VTE prophylaxis (6.7 ± 4.9 days vs. 4.7 ± 4.9 days, p < 0.001) compared to those that did not develop a VTE. Also, the combination SAH/SDH group was started on VTE prophylaxis significantly later (8.3 ± 6.1 days vs. 6.7 ± 3.9 days, p < 0.01) than the overall TBI group and had a higher incidence of VTE (14.4% vs. 10.4 %, p = NS). In contrast, patients sustaining isolated spinal injuries received chemical VTE prophylaxis significantly earlier (3.4 ± 4.2 days vs. 6.7 ± 3.9 days, p < 0.001) and had a significant decrease in their VTE rate (4.4% vs. 10.4%, P < 0.0001) compared to the overall TBI group. Conclusion Patients with VTEs had a significant delay in time to initiation of chemoprophylaxis compared to patients without VTEs. Patients sustaining a TBI had a 2-fold delay in initiation of chemoprophylaxis and an associated 2-fold increase in VTE events compared to patients who sustained spinal injuries. Of those patients who developed a TBI, patients who sustained a combination SAH/SDH had a significant delay in initiation of chemoprophylaxis with a higher rate of VTE events.