VTE Prophylaxis Should Usually Be Started Within 48 Hours in Severe TBI

Background: Severe traumatic brain injury (TBI), defined as a Glasgow Coma Scale (GCS) score ≤8, is becoming more common in the United States and around the world. As these patients may be immobile and have an increased thrombophilic environment, it is expected that more than half of patients will develop venous thromboembolism (VTE) if not treated prophylactically, and 20% to 30% will develop VTE even with mechanical prophylaxis. Heparins are often prescribed for chemical VTE prophylaxis (cVTEp), yet there is concern about hematoma expansion when these drugs are administered in the early phases of injury. Objective: To study the risks and outcomes of early versus late cVTEp among severe TBI patients. Design: Systematic review and meta-analysis. Methods: 4 large medical databases were searched for relevant articles. A total of 20 studies (comprising 289,511 patients) were included in the systematic review, and 14 studies were included in the meta-analysis. These studies are nicely su more...