Early Venous Thromboembolism Prophylaxis in Brain Injury Guidelines 1 and Brain Injury Guidelines 2 Traumatic Brain Injury Patients: A 5-Year Analysis

OBJECTIVES – Brain Injury Guidelines (BIG) was developed to reduce hospitalization of patients with mild traumatic brain injury (TBI). Limited data on venous thromboembolism (VTE) prophylaxis for patients were categorized as BIG 1 and BIG 2 hospitalized for non–TBI-related trauma. The aim of this study is to assess safety of early VTE prophylaxis among BIG 1 and BIG 2 patients. We hypothesize that early VTE prophylaxis is safe. METHODS – We performed retrospective analysis of 2017–2021 TBI database at our level 1 trauma center and included all adult trauma patients with TBI categorized as BIG 1 or BIG 2 who received thromboprophylaxis. Patients were stratified into EARLY (≤24 hours) and LATE (>24 hours) initiation of VTE prophylaxis. Outcomes were rates of repeat head computed tomography (RHCT) scan for neurological deterioration, mortality, deep vein thrombosis (DVT), and pulmonary embolism. Multivariable logistic regression was performed to identify independent effect of timing of VTE prophylaxis on outcomes. RESULTS – A total of 634 met the inclusion criteria. The mean age was 42, 62% were males, the mean systolic blood pressure was 129 mm Hg, and the median ISS was 13. There were 393 patients in EARLY group. Only 20 patients underwent RHCT with no difference between the groups (p = 0.398), with no worsening from index head CT. EARLY group had lower incidence of DVT (EARLY: 1% vs. LATE: 5%, p = 0.020) but no difference in pulmonary embolism (p = 0.620) or mortality (p = 0.265). On multivariable regression analysis, early VTE prophylaxis was associated with reducing risk of DVT (adjusted odds ratio, 0.341; 95% confidence interval, 0.121–0.783; p = 0.043). However, it was not associated with RHCT (p = 0.219) or mortality (p = 0.653). CONCLUSION – Early thromboprophylaxis for BIG 1 or BIG 2 trauma patients is safe and associated with reducing DVT risk without increasing risk of ICH progression or mortality. Future studies are needed to validate thromboprophylaxis risk-benefit ratio among BIG 1 and BIG 2 patients. LEVEL OF EVIDENCE – Therapeutic/Care Management; Level IV.