A 32 year old male is admitted to your trauma ICU after a head on motor vehicle collision. He was intubated in the resuscitation unit for altered mental status and was found to have bilateral subdural hematomas as well as a traumatic subarachnoid hemorrhage. At this point, the patient does not need an operation and the plan is to repeat the head CT at 6 and 24 hours to look for interval change.
Clinical question: At what point should you consider starting venous thromboembolic (VTE) prophylaxis in this patient?
Risk of VTE in patients with TBI
- Independent of pharmacological thromboprophylaxis strategy, VTE rate increases after TBI to 25% compared to the natural population.
- Severe head injury is in itself an independent risk factor for VTE.
Recommendations by the Brain Trauma Foundation (2007) – Level III Evidence
- Graduated compression stockings or intermittent pneumatic compression stockings (IPC’s) are recommended unless LE injury precludes use until the patient is ambulatory.
- Low molecular weight heparin (LMWH) or low dose unfractionated heparin (UFH) should be used in combination with mechanical prophylaxis. However, there is an increased risk for expansion in ICH.
- There is insufficient evidence to support recommendations regarding the preferred agent, dose, or timing of pharmacologic prophylaxis for DVT.
Share this Post