The safety of early pharmacological venous thromboembolism prophylaxis in patients with traumatic intracranial haemorrhage: a systematic review and meta-analysis

Balint Zoltan Borbas*, Peter Whitfield, Nicola King

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: In patients with traumatic intracranial haemorrhage (tICH) there is significant risk of both venous thromboembolism (VTE) and haemorrhage progression. There is a paucity of literature to inform the timing of pharmacological thromboprophylaxis (PTP) initiation. Aim: This meta-analysis aims to summarise the current literature on the timing of PTP initiation in tICH. Methods: This meta-analysis followed the Methodological Expectations of Cochrane Intervention Reviews checklist and the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Following the literature search, studies were matched against the criteria for inclusion. Data from included studies was pooled, analysed using random-effect analysis and presented as forest plots of risk ratios, except one result reported as difference of means. The ROBINS-I tool was used to assess the risk of bias in the studies. The GRADE approach was taken to assess the quality of included studies. Heterogeneity of studies was assessed using Tau2. Funnel plots were generated and used in conjunction with Harbord’s test and Rucker’s arcsine to assess for small-study effect including publication bias. Results: A total of 9927 ICH patients who received PTP were included from 15 retrospective observational cohort studies, 4807 patients received early PTP, the remaining 5120 received late PTP. The definition of early was dependent on the study but no more than 72-hours after admission. The mean age of the included cohort was 45.3 (std dev ±9.5) years, and the proportion of males was 71%. Meta-analysis indicated that there was a significant difference between early and late groups for the rate of VTE (RR, 0.544; p = 0.000), pulmonary embolus (RR, 0.538; p = 0.004), deep vein thrombosis (RR, 0.484; p = 0.000) and the intensive care unit length of stay (difference of means, −2.021; 95% CI, −2.250, −1.792; p = 0.000; Tau2 = 0.000), favouring the early group. However, the meta-analysis showed no significant difference between the groups for the rate of mortality (RR, 1.008; p = 0.936), tICH progression (RR, 0.853; p = 0.157), and neurosurgical intervention (RR, 0.870; p = 0.480). Conclusion: These findings indicated that early PTP appears to be safe and effective in patients with tICH.

Original languageEnglish
JournalBritish Journal of Neurosurgery
Early online date30 Apr 2024
DOIs
Publication statusE-pub ahead of print - 30 Apr 2024

ASJC Scopus subject areas

  • Surgery
  • Neurology (clinical)

Keywords

  • anticoagulation
  • early
  • Intracranial haemorrhage
  • timing

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