G. Liao1, N. K. Dhillon1, G. Barmparas1, A. Yang1, R. Mason1, S. Lahiri1, G. M. Thomsen1, E. J. Ley1 1Cedars-Sinai Medical Center,Los Angeles, CA, USA
Introduction: Early chemoprophylaxis is contraindicated in trauma patients with intracranial hemorrhage (ICH) despite the high risk for developing venous thromboembolism (VTE). We sought to determine if, and when, traumatic brain injury (TBI) patients received adequate VTE chemoprophylaxis with enoxaparin compared to trauma patients without brain injury.
Methods: A retrospective study was conducted in which the medical records of trauma patients who received adequate enoxaparin dosing based on anti-factor Xa trough levels were reviewed between August 2014 and October 2016. Data collected included patient demographics, injury characteristics, length of stay (LOS), enoxaparin administration details, anti-factor Xa trough levels, and imaging results.
Results: A total of 163 patients were analyzed of which 41 (25.2%) had TBI. The cohorts were similar with respect to age and sex. Head AIS, ISS, ICU LOS, and hospital LOS were increased among TBI patients. TBI patients waited longer before enoxaparin was started (7.5 vs. 1.5 day, p<0.01) and to achieve adequate dosing (11 vs. 5 days, p<0.01), as determined by anti-factor Xa trough levels. VTE rates were higher among TBI patients (22% vs. 9%, p=0.03). Four patients (12.5%) had progression of their ICH prior to receiving enoxaparin although none progressed during the course of enoxaparin administration.
Conclusion: There is a delay in providing TBI patients with adequate enoxaparin for VTE chemoprophylaxis despite a high presence of VTE. Judicious early administration of enoxaparin titrated by anti-factor Xa trough levels may be indicated.
