Effect of Very Early (<24 hours) Pharmacological Thromboprophylaxis on Clinical Outcome in Patients with Traumatic Intracranial Hemorrhage: A Systematic Review and Meta-Analysis

• Published in: World neurosurgery Vol. 202; p. 124419
• Main Authors: Zhou, Longshan, Xue, Xiujie, Chen, Qingshan, Xin, Yexin, Xiao, Yilei
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2025
• Subjects: Deep vein thrombosis; Hemorrhage; Neurosurgery; Pharmacologic thromboprophylaxis (PTP); Pulmonary embolism; Traumatic intracranial hemorrhage (TICH); Venous thromboembolism (VTE); DVT; OR; CI; VTE; Deep vein thrombosis; Hemorrhage; Traumatic intracranial hemorrhage (TICH); Venous thromboembolism (VTE); PTP; Pulmonary embolism; LMWH; PE; TBI; TICH; Pharmacologic thromboprophylaxis (PTP); Traumatic brain injury; Traumatic intracranial hemorrhage; Low molecular weight heparin; Pharmacologic thromboprophylaxis; Confidence interval; Odds ratio; Venous thromboembolism
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2025.124419

The risk of venous thromboembolism in patients with traumatic intracranial hemorrhage is high, but the safety and optimal timing of early pharmacologic thromboprophylaxis (PTP) are still controversial. Therefore, the objective of this study was to evaluate and summarize the impact of PTP initiation time point on patient-related clinical outcomes. This study systematically searched PubMed, EMBASE, and Cochrane databases (the database was established until 31 December 2024) and included 10 studies comparing very early (<24 hours) and delayed PTP (a total of 94,512 patients). The data were pooled using a fixed-effects model and expressed as odds ratio (OR) (95% confidence intervals). The findings demonstrated that very early PTP significantly reduced the risk of venous thromboembolism (OR = 0.39, 95% confidence interval 0.35–0.44), deep vein thrombosis (OR = 0.34, 0.30–0.39), and pulmonary embolism (OR = 0.48, 0.41–0.58). Furthermore, the study revealed that there was no increase in the risk of haemorrhage (OR = 1.19, 0.78–1.81). The findings of the study demonstrated that the mortality rate was not statistically significant after sensitivity analysis adjustment (OR = 0.90, 0.70–1.16). Egger and Begg tests (P > 0.05) showed no significant publication bias. Therefore, we believe that the initiation of PTP within 24 hours of admission in patients with traumatic intracranial hemorrhage has been demonstrated to reduce the risk of thrombosis and does not reveal significant bleeding progression.