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

• Published in: The American journal of surgery Vol. 223; no. 5; pp. 1004 - 1009
• Main Authors: Jakob, Dominik A., Benjamin, Elizabeth R., Recinos, Gustavo, Cremonini, Camilla, Lewis, Meghan, Demetriades, Demetrios
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2022; Elsevier Limited
• Subjects: Anticoagulants - therapeutic use; Cardiac arrhythmia; Cohort Studies; Complications; Disease prevention; Gender; Hematoma; Hematoma, Subdural, Acute - complications; Hematoma, Subdural, Acute - drug therapy; Hematoma, Subdural, Acute - surgery; Hemorrhage; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Hypotension; Mortality; Patients; Pharmacology; Prophylaxis; Regression analysis; Statistical analysis; Subdural hematoma; Thromboembolism; Trauma; Traumatic brain injury; Venous thromboembolism; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control; Venous thromboembolism; Subdural hematoma; Prophylaxis
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.07.048

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). 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. 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. 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. •Timing of VTEp has no effect on mortality or delayed craniectomy in patients with acute subdural hematomas.•Early VTEp (≤48 h) is associated with less thromboembolism complications compared to late VTEp (>48 h).•LMWH is independently associated with a lower mortality compared to UH.