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Invited Commentary
December 15, 2021

Adverse Outcomes With Early Venous Thromboembolism Prophylaxis in Neurosurgical Trauma Patients—Are We Crossing the Blood-Brain Barrier?

Author Affiliations
  • 1Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
  • 2Department of Surgery, Brooke Army Medical Center, San Antonio, Texas
  • 3Trauma Research Program, Scripps Mercy Hospital, San Diego, California
JAMA Surg. 2022;157(3):e215766. doi:10.1001/jamasurg.2021.5766

The risk of worsening traumatic brain injury (TBI) by initiating venous thromboembolism (VTE) chemoprophylaxis creates a conundrum for medical practitioners involved in trauma and neurosurgery. A resurgence of evidence has reexamined the timing of VTE prophylaxis and has strongly advocated that early (24 to 72 hours postinjury) administration is safe and not associated with increased bleeding or mortality for those with radiologically proven stable intracranial injuries.1,2 However, this research largely fails to adequately examine the subgroup of patients undergoing neurosurgical intervention and who are thus high risk by the Modified Berne-Norwood Criteria.3 Logic serves that these patients may be categorically different in their response to VTE prophylaxis not only owing to the severity of their injury but risk of periprocedural hemorrhage. However, many current guidelines cite weak or inadequate data to make substantial recommendations regarding VTE prophylaxis, and none differentiate this population of patients from the larger group of those with TBI.4-6 Here, Byrne and colleagues7 present some of the first data examining the risks and benefits of VTE prophylaxis, specifically in patients with TBI undergoing neurosurgical interventions.

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