Evaluating clinical outcomes for very early versus late venous thromboembolism prophylaxis in patients with isolated severe spinal trauma

• Very early initiation of VTE prophylaxis in severe spinal trauma reduces the risk of venous thromboembolism rates. • There was no significant increase in adverse outcomes with very early VTE prophylaxis following severe spinal trauma. • Very early VTE prophylaxis may be considered safe and effective in patients with severe spinal trauma. Very early initiation of VTE prophylaxis in severe spinal trauma reduces the risk of venous thromboembolism rates. There was no significant increase in adverse outcomes with very early VTE prophylaxis following severe spinal trauma. Very early VTE prophylaxis may be considered safe and effective in patients with severe spinal trauma. Patients with traumatic spinal injuries face a high risk of venous thromboembolism (VTE); however, the optimal timing of VTE prophylaxis to most effectively reduce VTE rates remains unclear. This study aims to assess the association between thromboprophylaxis timing and clinical outcomes in patients with traumatic spinal injuries. This retrospective cohort study used the ACS-TQIP database (2017–2023) to evaluate the timing of VTE prophylaxis in adult trauma patients (≥18 years) with isolated acute spinal cord injuries (SCI). Patients were stratified by prophylaxis type, management strategy, and spinal injury area. The primary outcomes were the odds of deep vein thrombosis (DVT) and pulmonary embolism (PE). Secondary outcomes included in-hospital mortality, complication rates, transfusion requirements, and ICU length of stay (ICU-LOS). Among severe spinal trauma patients, very early prophylaxis was associated with significant reductions in the odds of DVT (aOR: 0.387, p < 0.001, SE = 0.159) and PE (aOR: 0.342, p < 0.001, SE = 0.249) without increasing mortality or other complications. In patients undergoing operative management, only very early prophylaxis was associated with decreased odds of VTE (DVT: aOR: 0.506, p = 0.016, SE: 0.283; PE: aOR: 0.271, p = 0.035, SE: 0.620). Very early VTE prophylaxis resulted in a significant reduction in VTE rates without increasing adverse outcomes in patients with severe spinal trauma, regardless of spinal region, management strategy, and prophylaxis type.