Preliminary report on the safety of heparin for deep venous thrombosis prophylaxis after severe head injury.
BACKGROUND
Prophylaxis for venous thromboembolism (VTE) in head injured patients has avoided heparin products because of concern for exacerbating intracranial bleeding. The purpose of this study was to evaluate the safety of unfractionated heparin (UFH) for VTE prophylaxis after traumatic brain injury.


METHODS
We retrospectively evaluated the early use of UFH in patients sustaining a severe closed head injury (Abbreviated Injury Scale score > 3) from January 1, 2000, through December 31, 2000. Two groups were formed on the basis of the timing of UFH administration: within 72 hours of admission (Early group), or after the third day of hospitalization (Late group), if at all. Intracranial bleeding related to UFH administration was assessed by computed tomographic scan of the head and/or clinical examination.


RESULTS
Sixty-four of 76 patients with intracranial blood on admission head computed tomographic scan fulfilled study criteria. Seventy-three percent (n = 47) were in the Early group and 27% (n = 17) were in the Late group. None of the Early group had an increase in intracranial bleeding or deterioration on neurologic examination as a result of UFH administration. However, there was no statistical difference in VTE events between the two groups.


CONCLUSIONS
Early use of UFH in the severe head injured patient does not increase bleeding complications.
Department of Surgery, University of Cincinnati, Ohio, USA.
Joseph
J
Kim
Michelle M
MM
Gearhart
Andrew
A
Zurick
Mario
M
Zuccarello
Laura
L
James
Fred A
FA
Luchette
D015998:Abbreviated Injury Scale; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000175:diagnosis; D015897:Comorbidity; D016903:Drug Monitoring; D016489:Head Injuries, Closed / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin