Safety of heparin prophylaxis for venous thromboembolism in patients with neurotrauma

Introduction

Patients with neurotrauma are at high risk for VTE. The safety of early anticoagulation for neurotrauma has not been established. Our study was based on the hypothesis that unfractionated heparin can be safely administered to most patients with neurotrauma for VTE prophylaxis.

Methods

Prospective, single-cohort, observational study. All adult patients with neurotrauma admitted to a tertiary care teaching hospital in India from March to December 2007 received unfractionated heparin beginning approximately 24 hours after hospital admission until discharge. Brain CT scans were performed at admission, 24 hours after admission, and at variable intervals thereafter based on clinical course. Patients were excluded for coagulopathy, expected brain death or discharge within 48 hours. Complications of heparin prophylaxis were defined as expansion of existing intracranial haemorrhage or development of a new haemorrhagic lesion on follow-up CT after beginning heparin use.

Results

Twenty-one of 57 (36.8%) adult neurotrauma patients were eligible for heparin therapy. Their distribution of CT findings is presented in Table 1. Serial CT scan had progression of lesion in four of the 26 patients not on heparin therapy and in two of the 21 patients on heparin (P > 0.05). No difference in complications between patients with ICH on heparin (2/14) and not on heparin (1/13) were identified (P > 0.05). The mortality in the heparin group was 3/21(14.3%). Both the patients who developed worsening of CT findings after initiation of heparin therapy survived hospitalization. None of the patients suffered from DVT.

Table 1 Distribution of CT findings and heparin therapy

Conclusions

Heparin can be safely used for VTE prophylaxis in patients with head injury when started 24 hours after hospital admission.