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Deep Vein Thrombosis (DVT) Prophylaxis in Head-Injured Patients: Current Concepts and Guidelines
Ahmed Bakhsh, Hosam Shata Mohamed Ali, Ali Hassan Aljuzair, Umair Ahmed, Warda Rauf, Hany Eldawoody
Background: Abundant evidence from multiple randomized clinical trials conclusively showed that use of thromboprophylaxis in trauma patients is a safe, and effective for decreasing Venous Thromboembolism (VTE). However, despite these evidence-based guidelines, thromboprophylaxis remains either underutilized or suboptimal.
With this background, we analysed our own clinical practice regarding initiation of Deep vein thrombosis (DVT) prophylaxis in head-injured patients with or without polytrauma and to know how far our clinical practice is comparable with the existing guidelines.
Methods: All head injury admissions between September 2021 and September 2022 were selected for inclusion in this study. Patient data including age, sex, injuries, Glasgow Coma Scale (GCS), Injury Severity Score, were collected. Chemical prophylaxis, either heparin or enoxaparin, was started as soon as it was considered safe. Patients with traumatic intracranial hemorrhage were followed up with brain computed tomography to examine the safety of chemical DVT prophylaxis.
Results: A cohort of 100 patients was studied during the one year study period. Their average Glasgow Coma Scale (GCS) scores and Injury Severity Score scores were 11 and 14 respectively. Overall, 68% of patients suffered from mild to moderate head injuries. 59% of patients were poly-traumatized with different types of extra cranial injuries. 60% were managed conservatively and 40% needed surgical intervention. Overall, 75% of patients received chemical DVT prophylaxis and 25% received mechanical prophylaxis. 50% received early chemoprophylaxis that is within 72 hours, 25% received late prophylaxis that is after 72 hours. The average delay in start of DVT prophylaxis was 2.9 days. 2.4% of patients developed DVT in spite of prophylaxis but no one developed any expansion of intracranial hemorrhage.
Conclusions: This study concluded that early DVT prophylaxis in head-injured patients is safe and effective.