Effect of very early (<24 hours) pharmacological thromboprophylaxis on clinical outcome in patients with traumatic intracranial haemorrhage: a systematic review and meta-analysis

Patients with traumatic intracranial haemorrhage (TICH) have been shown to be at high risk of developing venous thromboembolism (VTE), yet the safety and optimal timing of early pharmacologic thromboprophylaxis (PTP) remains a subject of debate. The objective of this study was to evaluate and summarise the impact of PTP initiation time point on patient-related clinical outcomes. The databases of PubMed, EMBASE and Cochrane were systematically retrieved (the database was established until 31 December 2024), and the studies comparing very early (<24 hours) and delayed PTP were included. The data was pooled using a fixed-effects model and expressed as odds ratios(95% confidence intervals). This was done in accordance with PRISMA guidelines, and the risk of bias was assessed using the ROBINS-I tool. A total of 10 studies (involving a total of 94,512 patients) were included in the analysis. The findings demonstrated that very early PTP significantly reduced the risk of VTE (OR=0.39, 95%CI 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). Furthermore, Egger's test with Begg's test (p>0.05) suggested that there was no significant publication bias. The initiation of PTP within 24 hours of admission in patients with TICH has been demonstrated to reduce the risk of thrombosis and does not reveal significant bleeding progression.