Timing of VTE Chemoprophylaxis Varies Among Trauma Surgeons

Physician Reviewing CT Scans of Brain

In the United States alone, emergency rooms report more than 1.3 million traumatic brain injuries (TBIs) every year, 20% of which are fatal. Those who do recover from TBI are at higher risk of developing medical complications like venous thromboembolism (VTE), which typically causes blood clots in the arteries of the legs and lungs. An estimated one-half of TBI patients develop VTE at some point during the injury recovery process. While VTE may be addressed with mechanical treatments (such as compression devices), the effectiveness of therapies may be limited by other injuries and complications.

A second option for VTE treatment is chemoprophylaxis, the administration of medicine for disease prevention. Chemoprophylaxis is necessary in TBI patients with VTE, but trauma surgeons agree that timing is difficult: if medicine is administered too early, systemic bleeding may occur, but conservatively late administration may render the treatment ineffective. To address this problem, a research team in New York developed a twelve-item survey regarding the timing of chemoprophylaxis in TBI patients. Nearly four-hundred members of the American Board of Surgery completed the survey. Their responses indicated that:

  • Three-quarters of surgeons chose to initiate VTE chemoprophylaxis in their TBI patients.
  • Half of the respondents believed that their practice of VTE chemoprophylaxis was conservative.
  • Half of the surgeons reported that their institutions provided no standardized protocol regarding the administration of drugs to treat TBI-related VTE.

Though most surgeons agree that chemoprophylaxis is necessary for treating VTE in patients with TBI, there is wide variability in the timing and exact practice of these treatments. Further research into VTE chemoprophylaxis may influence clinical protocols, providing institutional guidance for surgeons and clinicians who treat patients with TBI.

Strollo BP, Bennett GJ, Chopko MS, et al. Timing of venous thromboembolism chemoprophylaxis after traumatic brain injury. Journal of Critical Care. (2017).
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