Early Venous Thromboembolism Prophylaxis With Enoxaparin in Patients With Blunt Traumatic Brain Injury

early enoxaparin for venous thromboem-bolism (VTE) prophylaxis in patients with blunt traumatic brain injury (TBI). Methods: Prospective observational study of patients with TBI who received enoxaparin within 48 hours after admission. Brain computed tomography (CT) scans were obtained at the time of admission, at 24 hours, and at variable intervals thereafter based on clinical course. Patients were ex-cluded from the study for intracerebral con-tusions>2 cm, multiple contusions within one brain region, subdural or epidural he-matomas>8 mm, increased size or number of lesions on follow-up CT, persistent intra-cranial pressure>20 mm Hg, or neurosur-geon or trauma surgeon reluctance to initiate early pharmacologic VTE prophylaxis. Bleed-ing complications were defined as CT pro-gression of hemorrhage by Marshall CT Classification or radiologists ’ report, re-gardless of any neurologic deterioration. Main outcomes measured were intracranial bleeding complications, discharge Glasgow Outcome Score, and hospital mortality. Results: Five hundred twenty-five pa-tients were studied. Eighteen patients (3.4%) had progressive hemorrhagic CT changes after receiving enoxaparin, 12 of whom had no change in treatment, neurologic status, or outcome. Six patients (1.1%) had a change in treatment or potential outcome, including three who required subsequent craniotomy. Twenty-one patients (4.0%) died, and pharmacologic prophylaxis may have contributed to one death (0.2%). Dis-charge Glasgow Outcome Scores were 445 (84.8%) good recovery, 19 (3.6%) moderate disability, 36 (6.8%) severe disability, 4 (0.8%) persistent vegetative state, and 21 (4.0%) dead. Conclusion: Enoxaparin should be considered as an option for early VTE prophylaxis in selected patients with blunt TBI. Early enoxaparin should be strongly considered in those patients with TBI with additional high risk traumatic injuries. Key Words: DVT prophylaxis in traumatic brain injury, Enoxaparin, DV