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Improving Mortality and Decreasing VTE after Severe Traumatic Brain Injury:Low Molecular Weight Heparin is Superior to Unfractionated Heparin
Elizabeth Benjamin, Gustavo Recinos, Alberto Aiolfi, Kenji Inaba, Demetrios Demetriades
USC Los Angeles County Medical Center, Los Angeles, CA

OBJECTIVE(S): Pharmacological venous thromboembolic (VTE) prophylaxis with Low Molecular Weight Heparin (LMWH) or Unfractionated Heparin (UH) is current standard of care in traumatic brain injuries (TBI). Experimental work shows heparinoids may have neuroprotective properties. Clinical work suggests LMWH may be more effective than UH for VTE prophylaxis in trauma patients. We hypothesized that LMWH is superior to UH in patients with severe isolated TBI.
METHODS: ACS TQIP database study including blunt severe TBI (AIS >3), receiving LMWH or UH VTE prophylaxis. Patients with severe extracranial injuries (AIS>3), mortality within 72 hours, or hospital stay < 72hrs were excluded. Demographic and physiologic data including age, gender, vital signs, GCS on admission, injury severity score (ISS), head, thorax and abdomen AIS, and timing of prophylaxis (within 48 hours, 49-72 hours and >72 hours) were collected. Outcomes included VTE complications, mortality, unplanned return to the operating room, ventilator days, ICU and hospital stay, and functional outcomes at discharge. Multivariate analysis was performed to compare outcomes between patients receiving LMWH and UH.
RESULTS: 20,417 patients met inclusion criteria for the study, 10018 (49.1%) received LMWH and 10399 (50.9%) UH. Multivariate analysis showed that LMWH was an independently protective against mortality and VTE complications, overall and in the subgroups of patients receiving prophylaxis within 48 hours, 49-72 hours and >72 hours. The type of prophylaxis had no effect on the need for unplanned return to the operating room.
CONCLUSIONS: LMWH prophylaxis in severe TBI is associated with better survival and lower VTE complications than UH.

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