Progression of Intracranial Hemorrhage Comparing Unfractionated Heparin versus Low Molecular Weight Heparin for Chemoprophylaxis in Traumatic Brain Injury.

Abstract

This study aims to compare the risk of intracranial hemorrhage (ICH) progression in traumatic brain injury (TBI) patients treated with unfractionated heparin (UFH) versus low molecular weight heparin (LMWH) for venous thromboembolism prophylaxis (VTEp). A retrospective review was conducted on TBI patients with ICH who were treated at a level 1 trauma center between January 2018 and July 2020. Patients included had 2 or more computed tomography head scans and received either UFH or LMWH within 24 hours after stable imaging. The primary outcome was ICH progression on follow-up computed tomography. Secondary outcomes included hospital and intensive care unit (ICU) length of stay (LOS). Among 335 patients (28% female and 72% male), 160 received UFH and 175 received LMWH. ICH progression after VTEp was higher in the UFH group (6.3% vs. 1.7%, P = 0.032). Hospital LOS and ICU LOS were longer in the UFH group (21.3 vs. 14.9 days, P = 0.027 and 11.1 vs. 6.5 days, P < 0.001, respectively) and remained longer after adjusting for risk level and injury mechanism. Multivariate analysis showed that LMWH was associated with a lower risk of ICH progression (odds ratio: 0.262, 95% confidence interval: 0.071-0.968, P = 0.045). Patients with multifocal lesions had higher odds of overall ICH progression. VTEp with LMWH in patients with TBI was associated with a lower risk of ICH progression, hospital LOS, and ICU LOS when compared to UFH. While cohort differences may have been contributory, LMWH remained independently associated with lower ICH progression and shorter LOS after adjusting for risk level and injury mechanism.