Is early venous thromboembolism prophylaxis safe and effective in trauma patients requiring urgent neurosurgical interventions: analysis of the prospective multicenter CLOTT study

Background: Timely initiation of venous thromboembolism prophylaxis (VTEp) has been known to decrease venous thromboembolism (VTE after trauma; however, early VTEp in patients undergoing neurosurgical interventions (NSIs) is controversial with conflicting reports in the literature from retrospective studies. We aimed to evaluate the safety and outcomes of early VTEp in this high-risk cohort. Methods: The study was a secondary analysis from the prospective multicenter Consortium of Leaders in the Study of Traumatic Thromboembolism database. Traumatic brain injury (TBI) patients receiving NSI were included. Patients were divided into early (≤72 hours) and late (>72 hours) VTEp groups. Mortality, VTE, deep vein thrombosis (DVT), pulmonary embolism, and bleeding adverse events including progression of intracranial hemorrhage (pICH) were compared. Results: Among the total 238 patients, 233 (97.9%) underwent craniotomy or craniectomy, and 140 (58.8%) received early VTEp. Patients with a head Abbreviated Injury Scale score of 5 and craniectomy were more likely to delay VTEp (>72 hours) (all p