• Asanthi M Ratnasekera, Sirivan S Seng, Daniel Kim, Wenyan Ji, Christina L Jacovides, Elinore J Kaufman, Hannah M Sadek, Lindsey L Perea, Christina Monaco Poloni, Ilya Shnaydman, Alexandra Jeongyoon Lee, Victoria Sharp, Angela Miciura, Eric Trevizo, Martin G Rosenthal, Lawrence Lottenberg, William Zhao, Alicia Keininger, Michele Hunt, John Cull, Chassidy Balentine, Tanya Egodage, Aleem T Mohamed, Michelle Kincaid, Stephanie Doris, Robert Cotterman, Sara Seegert, Lewis E Jacobson, Jamie Williams, Melissa Moncrief, Brandi Palmer, Caleb Mentzer, Nichole Tackett, Tjasa Hranjec, Thomas Dougherty, Shawna Morrissey, Lauren Donatelli-Seyler, Amy Rushing, Leah C Tatebe, Tiffany J Nevill, Michel B Aboutanos, David Hamilton, Diane Redmond, Daniel C Cullinane, Carolyne Falank, Mark McMellen, Chris Duran, Jennifer Daniels, Shana Ballow, Kevin M Schuster, and Paula Ferrada.
• Department of Surgery, Division of Trauma and Surgical Critical Care, Associate Professor of Surgery, Drexel College of Medicine, Philadelphia, PA, United States; Crozer Health Upland PA, Currently at Christianacare Health, Newark, DE, United States. Electronic address: ashanthi27@hotmail.com.
• Injury. 2024 Sep 1; 55 (9): 111523111523.

BackgroundIn patients with severe traumatic brain injury (TBI), clinicians must balance preventing venous thromboembolism (VTE) with the risk of intracranial hemorrhagic expansion (ICHE). We hypothesized that low molecular weight heparin (LMWH) would not increase risk of ICHE or VTE as compared to unfractionated heparin (UH) in patients with severe TBI.MethodsPatients ≥ 18 years of age with isolated severe TBI (AIS ≥ 3), admitted to 24 level I and II trauma centers between January 1, 2014 to December 31, 2020 and who received subcutaneous UH and LMWH injections for chemical venous thromboembolism prophylaxis (VTEP) were included. Primary outcomes were VTE and ICHE after VTEP initiation. Secondary outcomes were mortality and neurosurgical interventions. Entropy balancing (EBAL) weighted competing risk or logistic regression models were estimated for all outcomes with chemical VTEP agent as the predictor of interest.Results984 patients received chemical VTEP, 482 UH and 502 LMWH. Patients on LMWH more often had pre-existing conditions such as liver disease (UH vs LMWH 1.7 % vs. 4.4 %, p = 0.01), and coagulopathy (UH vs LMWH 0.4 % vs. 4.2 %, p < 0.001). There were no differences in VTE or ICHE after VTEP initiation. There were no differences in neurosurgical interventions performed. There were a total of 29 VTE events (3 %) in the cohort who received VTEP. A Cox proportional hazards model with a random effect for facility demonstrated no statistically significant differences in time to VTE across the two agents (p = 0.44). The LMWH group had a 43 % lower risk of overall ICHE compared to the UH group (HR = 0.57: 95 % CI = 0.32-1.03, p = 0.062), however was not statistically significant.ConclusionIn this multi-center analysis, patients who received LMWH had a decreased risk of ICHE, with no differences in VTE, ICHE after VTEP initiation and neurosurgical interventions compared to those who received UH. There were no safety concerns when using LMWH compared to UH.Level Of EvidenceLevel III, Therapeutic Care Management.Copyright © 2024 Elsevier Ltd. All rights reserved.

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