Abstract
Background and Objectives: Venous thromboembolism is a major complication associated with traumatic brain injury and is responsible for significant morbidity and mortality. There has been a general reluctance over the years to use anticoagulant prophylaxis for patients with head injury who have suffered intracranial bleeding or for whom intracranial surgery is needed. On the other hand, physical methods such as intermittent pneumatic compression (IPC) devices give a worthwhile reduction of venous thromboembolism but there still remains a substantial residual incidence. This study aimed at comparing physical-pharmacologic anti-thrombotic methods in these patients.
Material and Methods: Patients with severe head trauma (consciousness level lower than 8 on Glasgow Coma Scale) were studied in a clinical trial over a one-year period. These patients were randomly assigned to three groups (age and sex matched). IPC applied for all patients. Low dose heparin (5000 u/q12h S.Q) prescribed in one group and low molecular weight heparin ( Enoxaparin 40 mg/D) used in the other during the first 24-hour of admission. The incidence rate of deep vein thrombosis (DVT) was compared between the mentioned groups.
Results: Forty five patients (15 cases in each group) were enrolled. The number of patients with DVT in the mere physical-prophylaxis group, low dose heparin group and Enoxaparin group was 7 (46.6%), 2 (13.3%) and 3 (20%), respectively. There was no significant difference for the incidence rate of DVT between the mere physical-prophylaxis and low dose heparin groups (p=0.109), the mere physical-prophylaxis and Enoxaparin groups (p=0.121), and the low dose heparin and Enoxaparin groups (p=1). No hemorrhagic complication occurred.
Conclusion: The incidence rate of DVT is high in patients with severe head trauma. There was no significant difference between the mere physical and physical-pharmacologic anti-thrombotic methods; however the rate was lower in the latter. Further studies with larger sample size are recommended.