(1737) Chemical Thromboprophylaxis in Severe Traumatic Brain Injury: A Choice Unresolved

Introduction: Venous thromboembolism (VTE) prophylaxis in severe traumatic brain injury (sTBI) has a wide variance in clinical practice. Use of either low molecular weight heparin (LMWH) or unfractionated heparin is advocated by the American Association for the Surgery of Trauma Critical Care Committee Consensus from 2021 with a caveat that LMWH may be superior. The lack of high-level clinical data about the difference in effectiveness and individual safety profiles remains a concern. We aim to investigate through this study the superiority in choice of prophylaxis used and comparison of their respective complications in terms of hemorrhagic expansion and mortality.

Methods: We conducted a retrospective cohort study at a level one trauma center, including adult sTBI patients (≥18 years) admitted from August 2020 to June 2022. The primary endpoint was to investigate the rates of VTE in sTBI patients in each group who received heparin versus LMWH. Secondary endpoints included hemorrhagic complication, intensive care unit (ICU) length of stay (LOS), and discharge mortality.

Results: The analysis included 131 sTBI patients who received either heparin or LMWH for VTE prophylaxis. Among them, 111 patients (77.6%) received heparin as VTE prophylaxis, and 20 patients (14%) received LMWH. The age, gender, race, best Glascow Coma Scale (GCS), GCS motor score, Injury Severity Score and type of injury were similar without statistical significance between the groups. In the heparin group, 15% of patients developed VTE and similarly 10% of patients developed VTE in the LMWH group. There were no hemorrhagic complications in either group, such as hematoma expansion, with the use of VTE prophylaxis. Interestingly the ICU LOS is shorter in LMWH group (9.5 vs 13, p = 0.18) with a higher percentage of mortality (30% vs 12%, p = 0.08).

Conclusions: Our study demonstrated that either heparin or LMWH is effective in VTE prophylaxis in sTBI population, though the LMWH group demonstrated a higher rate of mortality which might be due to small sample size. Neither heparin nor LMWH caused hemorrhagic complications in sTBI population. Future larger study is warranted to confirm the equivalence of these two agents for VTE prophylaxis in sTBI population