• Neurosurgery · Dec 2017

    Early Venous Thromboembolism Chemoprophylaxis After Traumatic Intracranial Hemorrhage.

    • Fabio A Frisoli, Matthew Shinseki, Lynda Nwabuobi, Xiaopei L Zeng, Murillo Adrados, Carolyn Kanter, Spiros G Frangos, and Paul P Huang.
    • Department of Neurosurgery, New York University School of Medicine, New York, New York.
    • Neurosurgery. 2017 Dec 1; 81 (6): 1016-1020.

    BackgroundVenous thromboembolism is a common complication of traumatic brain injury with an estimated incidence of 25% when chemoprophylaxis is delayed. The timing of initiating prophylaxis is controversial given the concern for hemorrhage expansion.ObjectiveTo determine the safety of initiating venous thromboembolic event (VTE) chemoprophylaxis within 24 h of presentation.MethodsWe performed a retrospective analysis of patients with traumatic intracranial hemorrhage presenting to a level I trauma center. Patients receiving early chemoprophylaxis (<24 h) were compared to the matched cohort of patients who received heparin in a delayed fashion (>48 h). The primary outcome of the study was radiographic expansion of the intracranial hemorrhage. Secondary outcomes included VTE, use of intracranial pressure (ICP) monitoring, delayed decompressive surgery, and all-cause mortality.ResultsOf 282 patients, 94 (33%) received chemoprophylaxis within 24 h of admission. The cohorts were evenly matched across all variables. The primary outcome occurred in 18% of patients in the early cohort compared to 17% in the delayed cohort (P = .83). Fifteen patients (16%) in the early cohort underwent an invasive procedure in a delayed fashion; this compares to 35 patients (19%) in the delayed cohort (P = .38). Five patients (1.7%) in our study had a VTE during their hospitalization; 2 of these patients received early chemoprophylaxis (P = .75). The rate of mortality from all causes was similar in both groups.ConclusionEarly (<24 h) initiation of VTE chemoprophylaxis in patients with traumatic intracranial hemorrhage appears to be safe. Further prospective studies are needed to validate this finding.Copyright © 2017 by the Congress of Neurological Surgeons

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