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CC BY 4.0 · TH Open 2025; 09: a26161673
DOI: 10.1055/a-2616-1673
Original Article

In-Hospital Mortality and Hemorrhagic Risks in Traumatic Brain Injury Patients with Early vs. Late Venous Thromboembolism

Sophie Samuel
1   Memorial Hermann Texas Medical Center, Houston, Texas, United States
,
Jalon Barnes
1   Memorial Hermann Texas Medical Center, Houston, Texas, United States
,
Lynn Yamane
2   University of Texas, McGovern Medical School at UT Health, Houston, Texas, United States
,
Eugene Uh
2   University of Texas, McGovern Medical School at UT Health, Houston, Texas, United States
,
Cyprian C. Afunugo
2   University of Texas, McGovern Medical School at UT Health, Houston, Texas, United States
,
Bosco Seong Kyu Yang
2   University of Texas, McGovern Medical School at UT Health, Houston, Texas, United States
,
Huimahn Alex Choi
2   University of Texas, McGovern Medical School at UT Health, Houston, Texas, United States
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Abstract

Objective

This study reviewed the management and outcomes of traumatic brain injury (TBI) patients who developed venous thromboembolism (VTE) during hospitalization, focusing on the timing of VTE diagnosis and anticoagulation initiation.

Methods

This retrospective, single-center study utilized data from the University of Texas Trauma Database. Patients were categorized based on VTE diagnosis timing (early ≤7 days, late >7 days). The primary outcome was in-hospital mortality. Secondary outcomes included mortality specifically among patients who were receiving anticoagulation treatment, hemorrhagic complications, predictors associated with early anticoagulation initiation (defined as ≤ 7 days from VTE diagnosis), and whether anticoagulation timing influenced mortality.

Results

Among 237 patients (early: 145, late: 92), the mean age was 59 ± 20 years vs. 55 ± 20 years (p = 0.133). Males comprised 68% vs. 78% (p = 0.038). Subdural hematomas were the predominant injury (63% vs. 68%, p = 0.443). In-hospital mortality was similar (10% vs. 13%, p = 0.524) and did not differ between anticoagulated and non-anticoagulated patients (p = 0.94). Among patients who died, 73% in the early group and 100% in the late group had received anticoagulation (p = 0.053). Hemorrhage expansion was more frequent in early VTE patients (40% vs. 0%, p = 0.046). Pulmonary embolism was associated with early anticoagulation (OR = 1.86, 95% CI: 1.09–3.17, p = 0.023), while severe neurologic injury (GCS <9) reduced its likelihood (OR = 0.53, 95% CI: 0.28–0.98, p = 0.042).

Conclusion

In-hospital mortality did not differ by VTE timing or anticoagulation status. However, hemorrhage expansion was more frequent in early VTE patients, particularly those with subdural hematomas, emphasizing the need for individualized anticoagulation strategies.

Keywords

traumatic brain injury - venous thromboembolism - anticoagulation - subdural hematoma


Publication History

Received: 25 January 2025

Accepted: 24 April 2025

Article published online:
18 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Sophie Samuel, Jalon Barnes, Lynn Yamane, Eugene Uh, Cyprian C. Afunugo, Bosco Seong Kyu Yang, Huimahn Alex Choi. In-Hospital Mortality and Hemorrhagic Risks in Traumatic Brain Injury Patients with Early vs. Late Venous Thromboembolism. TH Open 2025; 09: a26161673.
DOI: 10.1055/a-2616-1673
 

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