The Safety of Early Thromboembolic Prophylaxis in Closed Traumatic Intracranial Hemorrhage

BACKGROUND: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in patients with traumatic brain injury (TBI); this study is testing the safety of enoxaparin use for the prevention of venous thromboembolism in this group of patients. PATIENTS AND METHODS: From January 2016 to May 2018, 46 patients (36 males, 10 females) with closed traumatic intracranial bleeding received early (ie, within 72 hours) venous thromboembolic prophylaxis with 40 mg of enoxaparin. Patients with traumatic intracranial hemorrhage were followed up both clinically and with repeated brain computed tomography to examine the safety of enoxaparin VTE prophylaxis. RESULTS: The age of the patients ranged from 16–91 years (43.9±25.8 years). Glasgow coma score ranged from 5–15 (9.9±4.7). Twenty patients had mild TBI (GCS 15–13), 17 patients had moderate TBI (GCS 12–9), and nine patients had severe TBI (GCS≤8). Brain computed tomography showed variable types of brain injuries. Non-surgical management was applied for 18 patients. Craniotomy and surgical evacuation of significant (≥1cm in maximum diameter) EDH and/or SDH was carried out in 26 patients. External ventricular drain was inserted in two patients with significant IVH. Thirty-eight patients had good overall outcome, eight patients showed poor outcome. None of the reviewed patients developed clinical deterioration and/or progression of the intracranial bleeding on follow-up brain CT scans. CONCLUSION: Enoxaparin is a safe prophylaxis against venous thromboembolism in patients with traumatic closed intracranial bleeding.