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Propensity weighted analysis of chemical venous thromboembolism prophylaxis agents in isolated severe traumatic brain injury: An EAST sponsored multicenter study
Journal article   Open access   Peer reviewed

Propensity weighted analysis of chemical venous thromboembolism prophylaxis agents in isolated severe traumatic brain injury: An EAST sponsored multicenter study

Asanthi M. Ratnasekera, Sirivan S. Seng, Daniel Kim, Wenyan Ji, Christina L. Jacovides, Elinore J. Kaufman, Hannah M. Sadek, Lindsey L. Perea, Christina Monaco Poloni, Ilya Shnaydman, …
Injury, v 55(9), 111523
01 Sep 2024
DOI: https://doi.org/10.1016/j.injury.2024.111523
PMID: 38614835
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://touroscholar.touro.edu/nymc_fac_pubs/7657View
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Abstract

Severe TBI VTE VTE agent VTE prophylaxis
•A multicenter retrospective review of 24 adult trauma centers, of isolated severe TBI patients who received UH or LMWH was conducted.•There were no differences in VTE, ICHE after VTE prophylaxis, or mortality.•Time to VTE did not differ between the two groups.•There are no safety concerns in initiating UH or LMWH in severe TBI population and initiation of either agent should be considered. In patients with severe traumatic brain injury (TBI), clinicians must balance preventing venous thromboembolism (VTE) with the risk of intracranial hemorrhagic expansion (ICHE). We hypothesized that low molecular weight heparin (LMWH) would not increase risk of ICHE or VTE as compared to unfractionated heparin (UH) in patients with severe TBI. Patients ≥ 18 years of age with isolated severe TBI (AIS ≥ 3), admitted to 24 level I and II trauma centers between January 1, 2014 to December 31, 2020 and who received subcutaneous UH and LMWH injections for chemical venous thromboembolism prophylaxis (VTEP) were included. Primary outcomes were VTE and ICHE after VTEP initiation. Secondary outcomes were mortality and neurosurgical interventions. Entropy balancing (EBAL) weighted competing risk or logistic regression models were estimated for all outcomes with chemical VTEP agent as the predictor of interest. 984 patients received chemical VTEP, 482 UH and 502 LMWH. Patients on LMWH more often had pre-existing conditions such as liver disease (UH vs LMWH 1.7 % vs. 4.4 %, p = 0.01), and coagulopathy (UH vs LMWH 0.4 % vs. 4.2 %, p < 0.001). There were no differences in VTE or ICHE after VTEP initiation. There were no differences in neurosurgical interventions performed. There were a total of 29 VTE events (3 %) in the cohort who received VTEP. A Cox proportional hazards model with a random effect for facility demonstrated no statistically significant differences in time to VTE across the two agents (p = 0.44). The LMWH group had a 43 % lower risk of overall ICHE compared to the UH group (HR = 0.57: 95 % CI = 0.32–1.03, p = 0.062), however was not statistically significant. In this multi-center analysis, patients who received LMWH had a decreased risk of ICHE, with no differences in VTE, ICHE after VTEP initiation and neurosurgical interventions compared to those who received UH. There were no safety concerns when using LMWH compared to UH. Level III, Therapeutic Care Management

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Collaboration types
Domestic collaboration
Web of Science research areas
Critical Care Medicine
Emergency Medicine
Orthopedics
Surgery
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