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Preliminary Report on the Safety of Heparin for Deep Venous Thrombosis Prophylaxis after Severe Head Injury

Kim, Joseph MD; Gearhart, Michelle M. PharmD; Zurick, Andrew BA; Zuccarello, Mario MD; James, Laura MS; Luchette, Fred A. MD

Journal of Trauma and Acute Care Surgery: July 2002 - Volume 53 - Issue 1 - p 38-43
Original Articles

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.

Conclusion  Early use of UFH in the severe head injured patient does not increase bleeding complications.

From the Departments of Surgery (J.K., L.J.), Pharmacy Services (M.M.G.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine (A.Z.), Cincinnati, Ohio, and the Division of Trauma, Critical Care, and Burns, Department of Surgery, Stritch School of Medicine, Loyola University, (F.A.L.), Maywood, Illinois.

Submitted for publication October 1, 2001.

Accepted for publication March 4, 2002.

This work was scheduled for poster presentation at the 61st Annual Meeting of the American Association for the Surgery of Trauma, which was canceled because of the terrorist attacks of September 11, 2001.

Address for reprints: Fred A. Luchette, MD, Department of Surgery, Stritch School of Medicine, Loyola University, 2160 South First Avenue, Maywood, IL 60153; email:

© 2002 Lippincott Williams & Wilkins, Inc.