Venous thromboembolic pharmacological prophylaxis in severe traumatic acute subdural hematomas: Early prophylaxis is effective and safe

Dominik A Jakob; Elizabeth R Benjamin; Gustavo Recinos; Camilla Cremonini; Meghan Lewis; Demetrios Demetriades

doi:10.1016/j.amjsurg.2021.07.048

Venous thromboembolic pharmacological prophylaxis in severe traumatic acute subdural hematomas: Early prophylaxis is effective and safe

Am J Surg. 2022 May;223(5):1004-1009. doi: 10.1016/j.amjsurg.2021.07.048. Epub 2021 Jul 31.

Authors

Dominik A Jakob¹, Elizabeth R Benjamin², Gustavo Recinos³, Camilla Cremonini⁴, Meghan Lewis⁵, Demetrios Demetriades⁶

Affiliations

¹ Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA. Electronic address: Dominik.a.jakob@gmail.com.
² Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA. Electronic address: Ebenja2@emory.edu.
³ Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA. Electronic address: Grecinos10@hotmail.com.
⁴ Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA. Electronic address: C.cremonini89@gmail.com.
⁵ Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA. Electronic address: Meghan.Lewis@med.usc.edu.
⁶ Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA. Electronic address: Demetrios.Demetriades@med.usc.edu.

PMID: 34364655
DOI: 10.1016/j.amjsurg.2021.07.048

Abstract

Background: The purpose of this study was to evaluate the optimal timing and type of pharmacological venous thromboembolism prophylaxis (VTEp) in patients with severe blunt head trauma with acute subdural hematomas (ASDH).

Methods: Matched cohort study using ACS-TQIP database (2013-2016) including patients with isolated ASDH. Outcomes of matched patients receiving early prophylaxis (EP, ≤48 h) and late prophylaxis (LP, >48 h) were compared with univariable and multivariable regression analysis.

Results: In 1,660 matched cases VTE complications (3.1% vs 0.5%, p < 0.001) were more common in the LP compared to the EP group. Multivariable regression analysis identified EP as an independent protective factor for VTE complications (OR 0.169, p < 0.001) but not mortality (p = 0.260). The adjusted risk for delayed craniectomy was not associated with EP compared to LP (p = 0.095). LMWH was independently associated with a lower mortality (OR 0.480, p = 0.008) compared to UH.

Conclusions: Early VTEp (≤48 h) does not increase the risk for craniectomies and is independently associated with fewer VTE complications in patients with isolated ASDH. LMWH was independently associated with a lower mortality compared to UH.

Keywords: Prophylaxis; Subdural hematoma; Venous thromboembolism.

MeSH terms

Anticoagulants / therapeutic use
Cohort Studies
Hematoma, Subdural, Acute* / complications
Hematoma, Subdural, Acute* / drug therapy
Hematoma, Subdural, Acute* / surgery
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Venous Thromboembolism* / etiology
Venous Thromboembolism* / prevention & control

Substances

Anticoagulants
Heparin, Low-Molecular-Weight