Retrospective cohort analysis of low-molecular-weight heparin versus non-vitamin k antagonist oral anticoagulants for venous thromboembolism prophylaxis across racial groups in hospitalized trauma patients

Background: Venous thromboembolism (VTE) is a significant risk factor for trauma, and low-molecular-weight heparin (LMWH) is the standard prophylactic treatment. Although direct oral anticoagulants (DOACs) may be convenient, their comparative effectiveness with LMWH in patients with trauma remains unclear, particularly across different racial groups. This study aimed to compare the efficacy and safety of DOACs and LMWH for VTE prophylaxis across racial groups in patients with trauma. Materials and methods: This retrospective cohort study included trauma patients with an Injury Severity Score ≥10 who received either LMWH or DOAC prophylaxis. We excluded patients under 18 years of age, those with contraindications to anticoagulants, and cases with missing outcome data. The primary outcomes were VTE events—deep vein thrombosis (DVT) and pulmonary embolism (PE)—and in-hospital mortality, with unplanned return to the operating room as the secondary outcome. Multiple imputations were used for missing data and a multivariable logistic regression with generalized estimating equations was adjusted for hospital-level clustering effects. Results: Among the 634,297 patients analyzed, 5,113 (0.8%) received DOACs, and 629,184 (99.2%) received LMWH. DOAC was associated with significantly higher VTE risk than LMWH (DVT: 3.3% versus 1.4%; PE: 2.0% versus 0.8%). Mortality was higher in the DOAC group, whereas no significant differences were noted in unplanned return to the operating room. Racial disparities were observed in thrombotic outcomes, with African Americans and Asians experiencing significantly higher VTE risk with DOAC than Caucasians. Conclusion: DOACs are associated with higher VTE and mortality rates than LMWH in major trauma patients, with African American and Asian patients experiencing disproportionately higher risks than Caucasians. These findings contradict the notion that certain racial groups might benefit more from DOAC prophylaxis and suggest that LMWH should remain the preferred option for VTE prophylaxis in patients with major trauma across all racial groups.