Sara Lauterwasser, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist
North Kansas City Hospital
North Kansas City, MO
Disclosure information not submitted.
Thanh-Nhi Lowe, PharmD, BCPS, BCCCP
Clinical Pharmacist - Trauma / Surgery
Truman Medical Center, United States
Disclosure information not submitted.
Michael Moncure, MD, FACS
General Surgeon
Truman Medical Center
Kansas City, United States
Disclosure information not submitted.
Dustin Neel, MD, FACS
Trauma Medical Director
University of Missouri Kansas City School of Medicine, United States
Disclosure information not submitted.
Kendra Black, MD
PGY-3 General Surgery Resident
University of Missouri Kansas City School of Medicine, United States
Disclosure information not submitted.
Calli Schardein, DO
PGY-2 General Surgery Resident
University of Missouri Kansas City School of Medicine, United States
Disclosure information not submitted.
Kari Jessip
Research and Statistics Graduate Student
University of Missouri Kansas City, United States
Disclosure information not submitted.
Kim Dyer, n/a
Clinical Research Coordinator
Truman Medical Center, United States
Disclosure information not submitted.
Theresa Lienhop, RN
Director of Trauma Services
Truman Medical Center, United States
Disclosure information not submitted.
Title: Safety comparison of venous thromboembolism prophylaxis in traumatic brain injury
Introduction: The Brain Trauma Foundation Guidelines state that low molecular weight heparin (LMWH) or unfractionated heparin may be used for chemical venous thromboembolism (VTE) prophylaxis. There have been very few studies that have directly compared enoxaparin and heparin for safety and efficacy when used for VTE prophylaxis in the traumatic brain injury (TBI) patient population.
Methods: The purpose of this study is to determine the safety of enoxaparin versus heparin for VTE prophylaxis in patients with a TBI. Secondary objectives are to determine the efficacy of enoxaparin versus heparin and to determine the time from trauma activation to VTE prophylaxis initiation. The study was completed at an urban academic medical center as a retrospective chart review of patients with a TBI, as confirmed by brain imaging. Data was collected over a two-year period.
Results: A total of 123 patients were included in the study. Seventeen patients received enoxaparin and the remaining received heparin. Re-bleeding or a progression of bleeding occurred in 11% of the patients in the heparin group compared to 0% in the enoxaparin group (p=0.144). There was no difference in the rate of new venous thromboembolism (VTE) between the enoxaparin group and heparin group. The rate of new VTE was 5.9% and 3.8%, respectively (p=0.683). Patients in the enoxaparin group had VTE prophylaxis initiated earlier with an average time to initiation of 32.9 ± 23.7 hours compared to 46.5 ± 32.4 hours in the heparin group (p=0.05).
Conclusion: The results from this study show a trend towards the safety of enoxaparin for venous thromboembolism prophylaxis in patients with a traumatic brain injury. The findings suggest that enoxaparin is appropriate to use for venous thromboembolism prophylaxis in the traumatic brain injury population, however, larger, randomized controlled trials are needed.