C. L. Shelley1, P. M. Arnold2, K. Udobi1, J. Green1, A. W. Bennett1, S. Berry1, J. M. Howard1, T. McDonald1, M. Moncure1, R. Winfield1 1University Of Kansas Medical Center,Trauma Surgery,Kansas City, KS, USA 2University Of Kansas Medical Center,Neurosurgery,Kansas City, KS, USA
Introduction: Traumatic brain injury (TBI) is a risk factor for the development of venous thromboembolism (VTE). Administration of low dose unfractionated heparin (LDUH) or low molecular weight heparin (LMWH) is an effective preventive strategy for this problem, but must be weighed against the risk of progression of intracranial hemorrhage. Studies have documented safety of VTE prophylaxis in TBI; however, no series has included routine follow up head CT after chemoprophylaxis initiation. The purpose of this study was to assess progression of intracranial hemorrhage after VTE prophylaxis using routine 24-hour head CT, which is standard practice at our institution.
Methods: A retrospective review of our level 1 trauma center’s registry from January 1, 2010 to December 31, 2015 was performed. Adult patients with head CT demonstrating TBI, subsequent initiation of VTE chemoprophylaxis, and repeat head CT obtained within 24 hours of initiation of chemoprophylaxis were included. Patients with history of coagulopathy were excluded.
Results: 1,120 records were reviewed. 255 met inclusion and exclusion criteria. Median post-injury start date for chemoprophylaxis was 4 days, with 159 patients receiving LDUH and 96 receiving LMWH. No patient had neurologic decline prior to scheduled 24-hour scan. Progression of hemorrhage occurred in 9 patients (3.5%); 7 had hemorrhage at a prior intervention site, 1 had a new lesion identified, and 1 had increase in an existing injury. Progression was not significantly different between patients receiving LDUH (n=7) and LMWH (n=2) (x ²=0.95, p=0.33). No patient required surgical intervention as a result of progression.
Conclusion: There is a low rate of progression of TBI seen on routine CT after initiation of VTE prophylaxis. There is no difference in progression rates between patients receiving LDUH or LMWH, but progression is more likely if patients undergo neurosurgical intervention. Intervention for progression of TBI is unlikely after VTE prophylaxis is initiated.