Anticoagulant chemoprophylaxis in patients with traumatic brain injuries: A systematic review

BACKGROUND Traumatic brain injury (TBI) continues to be a deadly injury. Universally accepted guidelines regarding the use of venous thromboembolism (VTE) chemoprophylaxis in trauma patients presenting with TBI have not been established. The purpose of this review was to identify and review the current literature and present the evidence for anticoagulant chemoprophylaxis regimens in patients with TBI. METHODS A search of five databases including PubMed, Web of Science, Google Scholar, JAMA Network, and Cochrane Journals was conducted for studies evaluating the safety and efficacy of venous thromboembolism prophylaxis regimens according to the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria were used for quality of evidence assessment. RESULTS Seventeen studies were included in this review: 1 randomized controlled trial, 2 prospective observational studies, 10 retrospective reviews, and 5 systematic reviews. Most studies demonstrated that early chemoprophylactic administration is associated with a decreased incidence of VTE in patients with TBI without an increase in intracranial bleed. CONCLUSION For patients with TBI resulting in intracranial hemorrhages, administration of VTE chemoprophylaxis is warranted for those patients with stable repeat computed tomography scans. Early chemoprophylaxis, at 24 to 72 hours is associated with reduced VTE incidence without a corresponding increase or exacerbation of intracranial hemorrhage in patients with TBI who have a stable repeat head computed tomography scan. More studies are needed to establish guidelines for the safety and efficacy of VTE prophylaxis protocols in adult patients with TBI. LEVEL OF EVIDENCE Systematic review, level III.