Timing of pharmacological thromboprophylaxis following traumatic brain injury: a UK-wide survey of clinical practice

Background
Traumatic brain injury (TBI) is associated with an increased risk of venous thromboembolism (VTE), which can complicate recovery from TBI, lead to long-term reductions in quality of life, and occasionally be fatal. There is no high-quality evidence to support recommendations for optimal timing, dosing or type of pharmacological thromboprophylaxis (PTP). This study aimed to characterise current clinical practice among healthcare professionals in the UK and Ireland regarding VTE prophylaxis in patients with TBI, to inform research.

Methods
An online survey was distributed to healthcare professionals across the UK and Ireland. The survey addressed types and timing of PTP in TBI patients, as well as factors influencing decision-making, use of imaging, ward-based scenarios, and local protocols.

Results
Responses were obtained from 61 individuals from 26 tertiary centres with neuroscience units. There was a heterogenous response with regards to the timing of PTP following TBI across all clinical scenarios, however, the most common factors contributing to decision making before starting VTE prophylaxis included progression of intracranial haemorrhage, new intracranial haemorrhage and prevention of VTE events. 85% of respondents agreed there is no high-quality evidence on the timing of starting pharmacological thromboprophylaxis after an acute TBI.

Discussion
This study underscores the lack of consensus for VTE prophylaxis in TBI patients. There is a pressing need for a randomised control trial to guide the optimal timing of PTP following TBI to improve patient care.