Venous thromboembolism in traumatic brain injury patients despite aggressive early chemoprophylaxis.

BACKGROUND

Venous thromboembolism (VTE) remains a serious complication after traumatic brain injury (TBI). This study examined the incidence and risk factors for VTE despite early, protocolized chemoprophylaxis (CP) with anti-Xa-based escalation.

METHODS

Retrospective cohort of adult polytrauma patients with TBI (9/16-12/21). Patients developing clinically significant deep vein thrombosis (DVT) or pulmonary embolism (PE) were compared to those without. Multivariable frequentist and Bayesian regression identified predictors of VTE.

RESULTS

Of 1554 patients, 54 (3.5 ​%) developed VTE (DVT 1.5 ​%, PE 1.5 ​%, both 0.5 ​%). Patients with VTE had higher injury severity (ISS 34 vs 27), lower GCS (3 vs 12), and greater base deficit. Mean time to prophylaxis was similar (56 vs 44 ​h). Heparin CP, enoxaparin dose escalation, and increased base deficit independently predicted VTE.

CONCLUSIONS

Despite early CP, VTE occurred in 3.5 ​% of patients. Enoxaparin remains standard; future efforts should minimize sub-prophylactic anti-Xa levels.

LEVEL OF EVIDENCE: Level III, prognostic/epidemiological.