Highlights
- •Timing of VTEp has no effect on mortality or delayed craniectomy in patients with acute subdural hematomas.
- •Early VTEp (≤48 h) is associated with less thromboembolism complications compared to late VTEp (>48 h).
- •LMWH is independently associated with a lower mortality compared to UH.
Abstract
Background
The purpose of this study was to evaluate the optimal timing and type of pharmacological
venous thromboembolism prophylaxis (VTEp) in patients with severe blunt head trauma
with acute subdural hematomas (ASDH).
Methods
Matched cohort study using ACS-TQIP database (2013–2016) including patients with isolated
ASDH. Outcomes of matched patients receiving early prophylaxis (EP, ≤48 h) and late
prophylaxis (LP, >48 h) were compared with univariable and multivariable regression
analysis.
Results
In 1,660 matched cases VTE complications (3.1% vs 0.5%, p < 0.001) were more common
in the LP compared to the EP group. Multivariable regression analysis identified EP
as an independent protective factor for VTE complications (OR 0.169, p < 0.001) but
not mortality (p = 0.260). The adjusted risk for delayed craniectomy was not associated
with EP compared to LP (p = 0.095). LMWH was independently associated with a lower
mortality (OR 0.480, p = 0.008) compared to UH.
Conclusions
Early VTEp (≤48 h) does not increase the risk for craniectomies and is independently
associated with fewer VTE complications in patients with isolated ASDH. LMWH was independently
associated with a lower mortality compared to UH.
Keywords
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Article info
Publication history
Published online: August 02, 2021
Accepted:
July 27,
2021
Received in revised form:
July 26,
2021
Received:
March 31,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
