Early VTE prophylaxis in severe traumatic brain injury: A propensity score weighted EAST multicenter study.

Asanthi M Ratnasekera, Daniel Kim, Sirivan S Seng, Christina Jacovides, Elinore J Kaufman, Hannah M Sadek, Lindsey L Perea, Christina Monaco, Ilya Shnaydman, Alexandra Jeongyoon Lee, Victoria Sharp, Angela Miciura, Eric Trevizo, Martin Rosenthal, Lawrence Lottenberg, William Zhao, Alicia Keininger, Michele Hunt, John Cull, Chassidy BalentineTanya Egodage, Aleem Mohamed, Michelle Kincaid, Stephanie Doris, Robert Cotterman, Sara Seegert, Lewis E Jacobson, Jamie Williams, Melissa Whitmill, Brandi Palmer, Caleb Mentzer, Nichole Tackett, Tjasa Hranjec, Thomas Dougherty, Shawna Morrissey, Lauren Donatelli-Seyler, Amy Rushing, Leah C Tatebe, Tiffany J Nevill, Michel B Aboutanos, David Hamilton, Diane Redmond, Daniel C Cullinane, Carolyne Falank, Mark McMellen, Christ Duran, Jennifer Daniels, Shana Ballow, Kevin Schuster, Paula Ferrada

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Patients with traumatic brain injury (TBI) are at high risk of venous thromboembolism events (VTE). We hypothesized that early chemical VTE prophylaxis initiation (≤24 hours of a stable head CT) in severe TBI would reduce VTE without increasing risk of intracranial hemorrhage expansion (ICHE).

METHODS: A retrospective review of adult patients 18 years or older with isolated severe TBI (Abbreviated Injury Scale score, ≥ 3) who were admitted to 24 Level I and Level II trauma centers from January 1, 2014 to December 31 2020 was conducted. Patients were divided into those who did not receive any VTE prophylaxis (NO VTEP), who received VTE prophylaxis ≤24 hours after stable head CT (VTEP ≤24) and who received VTE prophylaxis >24 hours after stable head CT (VTEP>24). Primary outcomes were VTE and ICHE. Covariate balancing propensity score weighting was utilized to balance demographic and clinical characteristics across three groups. Weighted univariate logistic regression models were estimated for VTE and ICHE with patient group as predictor of interest.

RESULTS: Of 3,936 patients, 1,784 met inclusion criteria. Incidences of VTE was significantly higher in the VTEP>24 group, with higher incidences of DVT in the group. Higher incidences of ICHE were observed in the VTEP≤24 and VTEP>24 groups. After propensity score weighting, there was a higher risk of VTE in patients in VTEP >24 compared with those in VTEP≤24 (odds ratio, 1.51; 95% confidence interval, 0.69-3.30; p = 0.307), however was not significant. Although, the No VTEP group had decreased odds of having ICHE compared with VTEP≤24 (odds ratio, 0.75; 95% confidence interval, 0.55-1.02, p = 0.070), the result was not statistically significant.

CONCLUSION: In this large multi-center analysis, there were no significant differences in VTE based on timing of initiation of VTE prophylaxis. Patients who never received VTE prophylaxis had decreased odds of ICHE. Further evaluation of VTE prophylaxis in larger randomized studies will be necessary for definitive conclusions.

LEVEL OF EVIDENCE: Therapeutic Care Management; Level III.

Original languageAmerican English
JournalJournal of Trauma and Acute Care Surgery
StatePublished - Jul 1 2023


  • Adult
  • Anticoagulants
  • Brain Injuries
  • Humans
  • Intracranial Hemorrhages
  • Propensity Score
  • Retrospective Studies
  • Traumatic
  • Treatment Outcome
  • Venous Thromboembolism


  • Surgery

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