Effectiveness of Low-Molecular-Weight Heparin versus Unfractionated Heparin for Venous Thromboembolism Prophylaxis after Firearm-Related Penetrating Brain Injury: A Retrospective Cohort Study from a Tertiary Care Trauma Center

Abstract

Background: Firearm-related penetrating brain injury is a severe form of traumatic brain injury associated with prolonged immobilization and an increased risk of venous thromboembolism. Pharmacological thromboprophylaxis is recommended in trauma patients; however, the optimal anticoagulant agent remains uncertain due to concerns regarding intracranial hemorrhage progression.

Objective: To compare the effectiveness and safety of low-molecular-weight heparin and unfractionated heparin for venous thromboembolism prophylaxis in patients with firearm-related penetrating brain injury.

Methods: A retrospective cohort study was conducted at POF Hospital Wah Cantt from January 2020 to December 2024. Adult patients with firearm-related penetrating brain injury who received thromboprophylaxis with either low-molecular-weight heparin or unfractionated heparin were included. The primary outcome was the incidence of venous thromboembolism during hospitalization. Secondary outcomes included intracranial hemorrhage progression, length of intensive care unit stay, and in-hospital mortality. Statistical analysis was performed using SPSS version 26.

Results: A total of 200 patients were included, with 102 receiving low-molecular-weight heparin and 98 receiving unfractionated heparin. The overall incidence of venous thromboembolism was 9%. Patients receiving low-molecular-weight heparin had a significantly lower incidence of venous thromboembolism compared with those receiving unfractionated heparin (5.9% vs 12.2%, p = 0.042). The rates of intracranial hemorrhage progression (6.9% vs 7.1%, p = 0.95) and in-hospital mortality (13.7% vs 18.4%, p = 0.34) were similar between the two groups. Multivariable logistic regression analysis demonstrated that low-molecular-weight heparin was independently associated with a reduced risk of venous thromboembolism.

Conclusion: Low-molecular-weight heparin appears to be more effective than unfractionated heparin for venous thromboembolism prophylaxis in patients with firearm-related penetrating brain injury without increasing the risk of intracranial hemorrhage progression.