DVT Prophylaxis in head-injured patients: Current Concepts and Guidelines

Abstract

Objective: DVT prophylaxis is often delayed in head -injured patients because clinicians believe that the risk of bleeding from prophylaxis is more critical than the risk of venous thromboembolism. Material & 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, 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 GCS scores and Injury Severity Score scores were 11 and 14 respectively. Overall, 68% of patients suffered from mild to moderate head injuries. Fifty-nine percent of patients were poly-traumatized with different types of extracranial 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 . Conclusion: This study concluded that early DVT prophylaxis in head-injured patients is safe and effective.