{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:25:15Z","timestamp":1789431915324,"version":"build-2803163510"},"reference-count":72,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a major source of morbidity and mortality following firearm-related penetrating brain injury (PBI). Standard pharmacological prophylaxis against VTE includes the use of low-molecular-weight heparin (LMWH) or unfractionated heparin (UH). However, the comparative effectiveness of LMWH versus UH to prevent VTE in this population remains unclear.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A retrospective analysis was conducted using data from the Trauma Quality Improvement Program (2017\u20132019) to evaluate the effectiveness of LMWH versus UH in patients with PBI. Adult patients (age \u2265 16 years) with an isolated firearm-related PBI treated at a level I or II trauma center were included. The primary outcome was the occurrence of VTE. Secondary outcomes were the need for late neurosurgical decompression and in-hospital mortality. Hierarchical logistic regression models were used to evaluate the association between prophylaxis type and the outcomes, adjusting for patient baseline and injury characteristics, as well as timing of VTE prophylaxis initiation. Effect modification was evaluated to determine whether the observed associations varied between types of early neurosurgical intervention: craniotomy\/craniectomy, intracranial monitor\/drain placement, or no intervention.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Among 2012 patients with isolated firearm-related PBI, LMWH was associated with 51% decreased odds of VTE compared with UH (OR 0.49, 95% CI 0.32\u20130.77) after risk adjustment. Subgroup analysis showed that LMWH, compared with UH, was associated with reduced odds of VTE in patients who underwent early craniotomy\/craniectomy (OR 0.42, 95% CI 0.23\u20130.74) or no intervention (OR 0.41, 95% CI 0.21\u20130.79). The type of pharmacological VTE prophylaxis was not associated with the occurrence of late neurosurgical decompression or in-hospital mortality.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In patients with firearm-related PBI, LMWH appears to be significantly more effective at preventing VTE compared with UH, without increasing the risk of neurosurgical intervention. These findings support the use of LMWH as the preferred agent for VTE prophylaxis after PBI.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.7.jns251092","type":"journal-article","created":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T01:40:32Z","timestamp":1769218832000},"page":"556-562","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of low-molecular-weight heparin versus unfractionated heparin for venous thromboembolism prophylaxis after firearm-related penetrating brain injury"],"prefix":"10.3171","volume":"144","author":[{"given":"Jiaqi","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health, Detroit, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saket","family":"Myneni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazin","family":"Elshareif","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaan","family":"Bhandarkar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas N.","family":"Vattipally","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tej D.","family":"Azad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"Byrne","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debraj","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Am J Surg","first-page":"380","article-title":"Incidence of venous thromboembolism in patients with traumatic brain injury","volume":"193","author":"Denson K","year":"2007","unstructured":"Denson K, Morgan D, Cunningham R, Incidence of venous thromboembolism in patients with traumatic brain injury. Am J Surg. 2007;193(3):380\u2013384."},{"issue":"1","key":"b2","series-title":"Neurocrit Care","first-page":"28","article-title":"Symptomatic venous thromboembolism: incidence and risk factors in patients with spontaneous or traumatic intracranial hemorrhage","volume":"11","author":"Kim KS","year":"2009","unstructured":"Kim KS, Brophy GM. Symptomatic venous thromboembolism: incidence and risk factors in patients with spontaneous or traumatic intracranial hemorrhage. Neurocrit Care. 2009;11(1):28\u201333."},{"issue":"5","key":"b3","series-title":"J Trauma","first-page":"1436","article-title":"Traumatic brain injury is associated with the development of deep vein thrombosis independent of pharmacological prophylaxis","volume":"66","author":"Reiff DA","year":"2009","unstructured":"Reiff DA, Haricharan RN, Bullington NM, Griffin RL, McGwin G, Rue LW. Traumatic brain injury is associated with the development of deep vein thrombosis independent of pharmacological prophylaxis. J Trauma. 2009;66(5):1436\u20131440."},{"issue":"2","key":"b4","series-title":"J Trauma Acute Care Surg","first-page":"238","article-title":"Isolated traumatic brain injury and venous thromboembolism","volume":"77","author":"Van Gent JM","year":"2014","unstructured":"Van Gent JM, Bandle J, Calvo RY, Isolated traumatic brain injury and venous thromboembolism. J Trauma Acute Care Surg. 2014;77(2):238\u2013242."},{"issue":"3","key":"b5","series-title":"JAMA Surg","first-page":"e215794","article-title":"Association of venous thromboembolism prophylaxis after neurosurgical intervention for traumatic brain injury with thromboembolic complications, repeated neurosurgery, and mortality","volume":"157","author":"Byrne JP","year":"2022","unstructured":"Byrne JP, Witiw CD, Schuster JM, Association of venous thromboembolism prophylaxis after neurosurgical intervention for traumatic brain injury with thromboembolic complications, repeated neurosurgery, and mortality. 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J Trauma Acute Care Surg. 2017;82(2):252\u2013262."},{"issue":"6","key":"b8","series-title":"J Trauma Acute Care Surg","first-page":"961","article-title":"Heparin versus enoxaparin for prevention of venous thromboembolism after trauma: a randomized noninferiority trial","volume":"79","author":"Olson EJ","year":"2015","unstructured":"Olson EJ, Bandle J, Calvo RY, Heparin versus enoxaparin for prevention of venous thromboembolism after trauma: a randomized noninferiority trial. J Trauma Acute Care Surg. 2015;79(6):961\u2013969."},{"issue":"10","key":"b9","series-title":"N Engl J Med","first-page":"701","article-title":"A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma","volume":"335","author":"Geerts WH","year":"1996","unstructured":"Geerts WH, Jay RM, Code KI, A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. 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