Abstract
Introduction
Blunt cerebrovascular injury (BCVI) can result in devastating stroke. Because of operative
inaccessibility, the most common treatment for BCVI is aspirin or a low-dose systemic
heparin infusion. While it is assumed that low dose heparin infusion imparts venous
thromboembolism (VTE) prophylaxis, this has not been evaluated in the BCVI population.
The purpose of this study was to evaluate VTE rates in patients receiving low-dose
heparin infusion as treatment for BCVI.
Methods
Patients diagnosed with BCVI between 2014 and 2018 were reviewed for initiation of
low-dose systemic heparin treatment. VTE was defined as a deep vein thrombosis or
pulmonary embolism. BCVI patients without systemic heparin treatment were compared
to BCVI patients with heparin treatment for overall VTE rates. Comparisons were also
made to injured patients without a BCVI in our Trauma Activation Protocol (TAP) database.
Results
During the 5-year study period, 265 patients were identified with a BCVI. The majority
(61%) were men with a median injury severity score (ISS) 22 (interquartile range [IQR]:14-33).
Of these patients, 146 (55.1%) received a heparin infusion to treat BCVI. VTE was
identified in eight of these patients (5.5%). Compared to TAP patients (n = 1020) who received standard dosing of VTE chemoprophylaxis, there was no difference
in VTE rates compared to BCVI patients who were started on a low dose heparin infusion
(3% versus 5.5%, P = 0.16). Area under the receiver operating characteristics (AUROC) was used to evaluate
the predictive power of time to initiation of heparin infusion (AUC = 0.64 95% CI
0.42-0.85, P = 0.2) and time to reaching PTT goal (AUC = 0.52 95% CI 0.27-0.77, P = 0.83) as a predictor VTE events.
Conclusions
Low dose heparin infusion is frequently used as an initial treatment of BCVI. In injured
patients with BCVI, a low dose heparin infusion is associated with a low rate of VTE,
comparable to injured patients without BCVI that received standard VTE chemoprophylaxis.
Keywords
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Article info
Publication history
Published online: January 27, 2023
Accepted:
September 28,
2022
Received in revised form:
September 3,
2022
Received:
May 25,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
