Early VTE Prophylaxis in Severe Traumatic Brain Injury: A Propensity Score Weighted EAST Multi-Center Study

BACKGROUND: Patients with 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 of age with isolated severe TBI (AIS ≥ 3) who were admitted to 24 level 1 and level 2 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 \u3e24 hours after stable head CT (VTEP\u3e24). Primary outcomes were VTE and ICHE. Covariate balancing propensity score weighting was utilized to balance demographic & clinical characteristics across three groups. Weighted univariate logistic regression models were estimated for VTE & 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\u3e24 group, with higher incidences of DVT in the group. Higher incidences of ICHE were observed in the VTEP≤24 and VTEP\u3e24 groups. After propensity score weighting, there was a higher risk of VTE in patients in VTEP \u3e24 compared to those in VTEP≤24 ( [OR] = 1.51; [95%CI] = 0.69-3.30; p = 0.307), however was not significant. Although, the No VTEP group had decreased odds of having ICHE compared to VTEP≤24 (OR = 0.75; 95%CI = 0.55-1.02, p = 0.070), the result was not statistically significant. CONCLUSIONS: 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: level III, Therapeutic Care Management