Introduction: Patients with traumatic brain injury (TBI) are at risk for development of thromboembolic disease (TE). The use of chemoprophylaxis in this patient group has not fully been characterized. We hypothesize that early chemoprophylaxis in patients with TBI is safe and efficacious.
Methods: In May 2009, a protocol was instituted for patients with TBI where chemoprophylaxis for TE with either 30mg of Lovenox twice daily or 5000U of Heparin three time a day was initiated 24 hours after an intracranial hemorrhage (ICH) was demonstrated as stable on head CT. Two cohorts were evaluated; cohort 1 included patients from May 2008 – April 2009 who had no routine administration of chemoprophylaxis, and cohort 2 included patients from May 2009 – May 2010, after the protocol was instituted. The groups were compared with the major outcomes being deep venous thrombosis (DVT), pulmonary embolism (PE) and increase in size of ICH.
Results: 312 patients with TBI were seen during the study course and 236 patients met criteria for inclusion in the study; 107 patients in cohort 1 and 129 patients in cohort 2. DVT rate for cohort 1 was 6 occurrences (5.61%) and 0 occurrences (0%) in cohort 2, which was a statistically significant difference (p=0.0080). PE was found in 4 patients for cohort 1 (3.74%) and 1 patient in cohort 2 (0.78%), a difference that did not reach statistical significance (p=0.18). 3 instances of increased ICH occurred after starting anticoagulation for chemoprophylaxis in cohort 1 (2.8%) and 1 patient in cohort 2 (0.7%) was not statistically different (p=0.33).
Conclusions: Use of chemoprophylaxis in traumatic brain injury 24 hours after stable head CT is safe and decreases the rate of DVT formation.
Patient Care: Early chemoprophylaxis for thromboembolic disease may reduce the risk of DVT and PE in patients suffering from traumatic disease with intracranial hemorrhage.
Learning Objectives: At the conclusion of this session participants should be able to 1) Describe the importance of thromboembolism prophylaxis. 2) Discuss, in small groups the controversy surrounding chemoprophylaxis in trauma. 3) Identify an effective treatment for thromboembolism prophylaxis.