Abstract
No standard exists for venous thromboembolism (VTE) prophylaxis after traumatic brain
injury (TBI). Caregivers agree that there is an early time point after injury in which
the chances of spontaneous injury progression are high and the risks of prophylactic
anticoagulation are excessive, and that these injuries eventually stabilize to the
point that anticoagulation may be safely started. Translating this consensus into
an application that can inform bedside decision making has not occurred. National
groups have promulgated guidelines in the United States suggesting that anticoagulants
be used when the risk of renewed intracranial hemorrhage has ceased with no guidance
beyond this vague recommendation. This is largely due to the relative paucity of literature
about pharmacologic prophylaxis, which has in turn been due to fears of propagation
of intracranial hemorrhage. Although interest in this field has increased of late,
many studies are limited by the simple dichotomization of TBI patients as having the
presence or absence of intracranial blood. Although methodologically easier, this
approach does not account for the heterogeneity of TBI and, consequently, the spectrum
of time to stabilization. To address this, our group has created an algorithm which
stratifies patients by risk for spontaneous progression and tailors a unique VTE prophylaxis
regimen to each arm.
Keywords
traumatic brain injury - venous thromboembolism - prophylaxis - anticoagulation
