Safety and efficacy of early thromboembolism chemoprophylaxis after intracranial hemorrhage from traumatic brain injury

Clinical article

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Patients with traumatic brain injury (TBI) are at risk for development of thromboembolic disease. The use of chemoprophylaxis in this patient group has not fully been characterized. The authors hypothesize that early chemoprophylaxis in patients with TBI is safe and efficacious.


In May 2009, a protocol was instituted for patients with TBI where chemoprophylaxis for thromboembolic disease (either 30 mg of Lovenox twice daily or 5000 U of heparin 3 times a day) was initiated 24 hours after an intracranial hemorrhage (ICH) was demonstrated as stable on head CT image. Two cohorts were evaluated: Cohort A included patients from May 2008 through April 2009 who had no routine administration of chemoprophylaxis, and Cohort B included patients from May 2009 through May 2010 after the protocol was instituted. The groups were compared, with the major outcomes being deep venous thrombosis (DVT), pulmonary embolism, and increase in size of ICH.


Of the 312 patients with TBI who were seen during the study course, 236 patients met criteria for inclusion in the study: 107 patients in Cohort A and 129 patients in Cohort B. The DVT rate was 6 occurrences (5.61%) in Cohort A and 0 occurrences (0%) in Cohort B, which was a statistically significant difference (p = 0.0080). Pulmonary embolism was found in 4 patients (3.74%) in Cohort A and 1 patient (0.78%) in Cohort B, a difference that did not reach statistical significance (p = 0.18). Three instances (2.8%) in Cohort A and 1 instance (0.7%) in Cohort B of increased ICH occurred after starting anticoagulation for chemoprophylaxis; this was not statistically different (p = 0.33).


Use of chemoprophylaxis in TBI 24 hours after stable head CT is safe and decreases the rate of DVT formation.

Abbreviations used in this paper:AIS = Abbreviated Injury Scale; DVT = deep vein thrombosis; GCS = Glasgow Coma Scale; ICH = intracranial hemorrhage; ISS = Injury Severity Score; LOS = length of stay; PE = pulmonary embolism; TBI = traumatic brain injury; VTE = venous thromboembolism.

Article Information

Address correspondence to: N. Scott Litofsky, M.D., Division of Neurological Surgery, University of Missouri-Columbia School of Medicine, One Hospital Dr., MC 321, Columbia, MO 65212. email:

Please include this information when citing this paper: published online September 20, 2013; DOI: 10.3171/2013.8.JNS13424.

© AANS, except where prohibited by US copyright law.



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    University of Missouri TBI DVT prophylaxis protocol. aPTT WNL = activated partial thromboplastin time within normal limits; INR = international normalized ratio; plts = platelets; PT = prothrombin time; SCD = sequential compression device.

  • View in gallery

    A and B: CT scans obtained in a patient with a subarachnoid hemorrhage (large arrow), contusion (small arrow), and punctuate hemorrhage (open arrow). C and D: CT scans obtained 24 hours after admission with progression of contusion (small arrow) and punctate hemorrhage (open arrow), delaying initiation of chemoprophylaxis.



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