Prophylactic Chemical Anticoagulation Following TBI

 

VBMC TRAUMA CARE SERVICES GUIDELINE

TITLE: Prophylactic chemical anti-coagulation following traumatic brain injury
PURPOSE: Provide guidelines for the safe and effective use of chemical prophylaxis against deep vein thrombosis and venous thromboembolism

 

GUIDELINE:

Major trauma patients are at increased risk for venous thrombosis and embolism. Traumatic brain injury is recognized as an independent risk factor for deep vein thrombosis (DVT). Prophylaxis against DVT in an effort to prevent venous thromboembolism (VTE) and its complications is standard therapy for all trauma patients. Current recommendations for from the Brain Trauma Foundation support the use of SCDs in combination with chemical prophylaxis. Large clinical trials of series > 500 patients have demonstrated a rate of progression for intracranial hemorrhage of 1-4%, a rate not different than that of patients who receive no chemical prophylaxis.

 

In order to decrease the rate of DVT and ultimately the rate of VTE, major trauma patients suffering TBI without other contraindication or scheduled operative interventions should receive SCDs on admission with the addition of chemical prophylaxis based on the following guideline.

 

Follow-up CT scan of the brain should be performed at 24 hours post injury. If progression of the initial injury is identified chemical prophylaxis should not be initiated at that time. If on repeat CT scan of the brain at 24 hours no injury progression is identified, chemical prophylaxis should be initiated at 48 hours post injury unless contraindicated based on other injuries.

DVT Prophylaxis Following Traumatic Brain Injury

RESOURCE/REFERENCES:

Safety and Efficacy of prophylactic Anticoagulation in patients with Traumatic Brain Injury. Scudday et al. JACS. July 2011.
Guidelines For the Management of Severe Traumatic Brain Injury. Brain Trauma Foundation. J Neurotrauma, 2007.

Early Venous Thromboembolism Prophylaxis with enoxaparin in Patients with Blunt Traumatic Intracranial Hemorrhage, J Trauma 2008.