What does this research mean for the field?

Early pharmacologic VTE prophylaxis (≤48 hours) in patients with intracerebral hemorrhage results in similar VTE incidence and hematoma enlargement compared to delayed initiation (>48 hours). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study assesses how the timing of starting venous thromboembolism prophylaxis affects the risk of complications after intracerebral hemorrhage.

April 5, 2026

Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis in Patients With Intracerebral Hemorrhage

Key Result

Early VTE prophylaxis (≤48h) in intracerebral hemorrhage resulted in similar VTE incidence (5% vs 8%) and hematoma enlargement (16% vs 15%) compared to delayed initiation (>48h).

Key Points

This study assesses how the timing of starting venous thromboembolism prophylaxis affects the risk of complications after intracerebral hemorrhage.
Conducted as a multicenter, retrospective cohort study.
Included patients with nontraumatic intracerebral hemorrhage from August 2023 to July 2024.
Categorized patients based on early (≤48 h) versus delayed (>48 h) initiation of VTE prophylaxis.
No significant difference in VTE incidence between early (5%) and delayed (8%) prophylaxis, P = 0.713.
Secondary outcomes also showed no significant differences in deep vein thrombosis and pulmonary embolism rates.
Hematoma enlargement rates were similar at 16% for early vs. 15% for delayed, P = 0.623.

Structured PICO

Does early initiation of pharmacologic VTE prophylaxis reduce the incidence of VTE in patients with intracerebral hemorrhage?

Population

111 patients with nontraumatic intracerebral hemorrhage admitted to 7 community hospitals

Intervention

Early initiation of pharmacologic venous thromboembolism (VTE) prophylaxis (≤48 hours from ICH onset)

Comparator

Delayed initiation of pharmacologic venous thromboembolism (VTE) prophylaxis (>48 hours from ICH onset)

Outcome

Incidence of venous thromboembolism (VTE)hard clinical

Early initiation of pharmacologic VTE prophylaxis (≤48 hours) in patients with intracerebral hemorrhage did not significantly reduce VTE incidence or increase hemorrhagic complications compared to delayed initiation, though the study may have been underpowered.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Objective: Optimal timing of initiation of pharmacologic venous thromboembolism (VTE) prophylaxis following intracerebral hemorrhage is controversial. This study aims to assess the association between the timing of pharmacologic VTE prophylaxis initiation and the risk of VTE and hemorrhagic complications. Methods: This was a multicenter, retrospective cohort study completed at 7 community hospitals. This study included patients with nontraumatic intracerebral hemorrhage admitted from August 1, 2023, to July 31, 2024. A total of 111 patients were assessed and categorized based on the administration of early (≤48 h) versus delayed (>48 h) initiation of VTE prophylaxis. Results: Findings showed no statistically significant difference in the primary outcome of the incidence of VTE with early versus delayed initiation of VTE prophylaxis (5% vs. 8%, P =0.713). Secondary outcomes included incidence of deep vein thrombosis (5% vs. 8%, P =0.713), pulmonary embolism (0% vs. 0%), hematoma enlargement (16% vs. 15%, P =0.623), median intensive care unit (ICU) length of stay (3 vs. 3.5 d, P =0.670), hospital length of stay (7 vs. 8 d, P =0.724), inpatient all-cause mortality (8% vs. 7%, P =1.000), and discharge disposition. Conclusion: Early pharmacologic VTE prophylaxis (≤48 h from ICH onset) was not found to be statistically significant in lowering the incidence of VTE. This occurred with no statistically significant differences in hematoma enlargement, increased inpatient mortality, or increased length of ICU/hospital stay. Additional adequately powered studies are needed to determine if early pharmacologic VTE prophylaxis is associated with a lower incidence of VTE.

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