Is early venous thromboembolism prophylaxis safe and effective in trauma patients requiring urgent neurosurgical interventions: analysis of the prospective multicenter CLOTT study.
Publication/Presentation Date
1-1-2026
Abstract
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< 0.05). Compared with late VTEp, early VTEp exhibited lower rates of VTE (10.7% vs 16.3%, p=0.28) and DVT (8.6% vs 15.3%, p=0.16), though without achieving statistical significance. Through generalized estimating equation and competing risk analysis, early VTEp did not demonstrate a significant decrease of VTE risk (OR) 0.74, 95% CI 0.33 to 1.67; HR 0.90, 95% CI 0.45 to 1.84), whereas the risk of adverse bleeding events (OR 0.79, 95% CI 0.24 to 2.57) or pICH (OR 1.10, 95% CI 0.30 to 4.03) did not increase with early VTEp either.
CONCLUSION: Early VTEp is not significantly associated with reduced rates of VTE or DVT in patients with severe TBI requiring emergent NSI, but it also does not increase the risk of adverse bleeding event or pICH.
LEVEL OF EVIDENCE: Level IV; therapeutic/care management.
Volume
11
Issue
1
First Page
001884
Last Page
001884
ISSN
2397-5776
Published In/Presented At
Wu, Y., Gruen, J. P., Matsushima, K., Schellenberg, M., Inaba, K., Moore, E. E., Sauaia, A., Knudson, M. M., Martin, M. J., & CLOTT Study Group (2026). Is early venous thromboembolism prophylaxis safe and effective in trauma patients requiring urgent neurosurgical interventions: analysis of the prospective multicenter CLOTT study. Trauma surgery & acute care open, 11(1), e001884. https://doi.org/10.1136/tsaco-2025-001884
Disciplines
Medicine and Health Sciences
PubMedID
41659917
Department(s)
Department of Surgery
Document Type
Article