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Early administration of high dose enoxaparin after traumatic brain injury

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Early enoxaparin 30 mg BID administration at 24 h post-injury has been demonstrated in patients with traumatic brain injury (TBI). However this dose can also yield subtherapeutic anti-Xa levels in 30–50% of trauma patients, suggesting that larger doses may be required for adequate prophylaxis against venous thromboembolism (VTE). The safety of enoxaparin 40 mg BID in trauma patients has previously been shown – however, these studies have largely excluded TBI patients. Therefore, we sought to demonstrate the safety of early enoxaparin 40 mg BID in a low-risk group of TBI patients.

Methods

A retrospective review of TBI patients at a Level 1 trauma center was performed. Patients with stable computed tomography (CT) of the head at 6 to 24 h post-injury who received enoxaparin 40 mg BID were included and serial GCS evaluations to identify possible clinical complications. To evaluate the safety of this dosing regimen, data was then compared to patients from our institution with similar TBI profiles who had received 5,000 units (U) of subcutaneous heparin (SQH) prophylaxis.

Results

199 TBI patients were identified over a nine month period, 40/199 (19.7%) received DVT prophylaxis after traumatic injury. Of these 40, 19 (47.5%) received enoxaparin 40 mg BID and 21 (52.5%) received 5,000U of SQH. Low risk TBI patients who were either given enoxaparin (n = 7) or SQH (n = 4), demonstrated no clinical decline in mental status during their inpatient stay.

Conclusion

Prior studies have demonstrated that enoxaparin 40 mg BID dosing is superior to traditional VTE prophylaxis in trauma patients. However, TBI patients are often excluded from this dosing due to concern for progression. Our study showed no clinical decline in mental status in a small cohort of low-risk TBI patients who received enoxaparin 40 mg BID.

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Data availability

Detailed data is available per request to the corresponding author.

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Authors and Affiliations

  1. Division of Burns, Trauma and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA

    Young-Woo Cho, Marinda Scrushy, Michelle Zhu, Elizabeth DeAtkine, Michelle Zhu, Bingchun Wan, Alyssa Fesmire, Michael Cripps & Caroline Park

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  1. Young-Woo Cho
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  2. Marinda Scrushy
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  3. Michelle Zhu
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  4. Elizabeth DeAtkine
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  5. Michelle Zhu
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  6. Bingchun Wan
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  7. Alyssa Fesmire
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  8. Michael Cripps
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  9. Caroline Park
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Contributions

Literature review, data collection: YC, MS, MZ, ED, AF. Data analysis and writing: YC, MS, MZ, ED, BW, AF, MC, CP. Study design and data interpretation and critical revisions: YC, MS, MZ, BW, MC, CP.

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Correspondence to Caroline Park.

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Authors report no relevant disclosures or conflicts of interest.

Ethical statement

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Cho, YW., Scrushy, M., Zhu, M. et al. Early administration of high dose enoxaparin after traumatic brain injury. Eur J Trauma Emerg Surg 49, 2295–2303 (2023). https://doi.org/10.1007/s00068-023-02317-6

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  • DOI: https://doi.org/10.1007/s00068-023-02317-6

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