Faculty, Staff and Student Publications

Language

English

Publication Date

1-1-2025

Journal

Trauma Surgery & Acute Care Open

DOI

10.1136/tsaco-2024-001606

PMID

41035963

PMCID

PMC12481404

PubMedCentral® Posted Date

9-30-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Objectives: Patients with traumatic intracranial hemorrhage (ICH) often undergo early stability CT scans to evaluate for progression of bleeding. The factors associated with progression after initiating venous thromboembolism (VTE) chemoprophylaxis (CP) remain poorly described. This study aimed to determine the rate of and factors associated with ICH progression following CP initiation.

Methods: This retrospective observational study included adult (≥16 years) polytrauma patients with blunt or penetrating traumatic brain injury (TBI) admitted between September 2016 and December 2021. Progression was defined as a radiographic increase in ICH following VTE CP initiation, determined by neurosurgery or radiology faculty. Postprophylaxis CT scans were obtained based on clinical deterioration. Associated factors, neurosurgical intervention rates, and outcomes were evaluated.

Results: Among 1390 included patients, ICH progression occurred in 3% (43) following CP initiation. Patients with progression were older (55 vs 45 years) and had higher injury severity scores (33 vs 27; p< 0.05). Rates of pneumonia (49% vs 21%) and sepsis (19% vs 9%) were higher in the progression group (p< 0.05). There was no difference between groups in time to prophylaxis initiation (40 vs 38 hours), survival (88% vs 92%), or VTE incidence (0% vs 4%; all p=NS). Factors associated with progression included midline shift (21% vs 6%), subdural hematoma (47% vs 26%), and prior progression on 6-hour stability CT (64% vs 34%; p< 0.05). Multivariate analysis confirmed these findings. Among progression patients, 9% required intervention after CP, with only two requiring craniotomy.

Conclusions: ICH progression is rare (3%) after VTE CP initiation. Associated factors align with spontaneous progression, suggesting that ICH progression is independent of early VTE prophylaxis (< 48 hours). These findings support the safety of early VTE CP as the standard of care for mitigating VTE risk in TBI patients with TBI.

Level of evidence: Level III, retrospective study with up to two negative criteria.

Keywords

intracranial hemorrhage; Venous thromboembolism; Brain Injuries, Traumatic; Anticoagulants

Published Open-Access

yes

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