Abstract Number: Esoc2026a896 Optimal Timing for Pharmacological Vte Prophylaxis in Traumatic Brain Injury: A Network Meta-Analysis of 13,173 Patients

Background and aims Traumatic brain injury (TBI) patients are at significant risk for venous thromboembolism (VTE), however pharmacologic treatment is generally delayed due to concerns about cerebral hemorrhage. ICH patients had a higher VTE risk than ischemic stroke patients, however prophylactic timing is unknown. This network meta-analysis examines how VTE prophylaxis beginning times affect TBI patients. Methods We performed a systematic search in WOS, PubMed, Cochrane, and Scopus up to December 2024 to identify RCTs and observational studies comparing early vs. delayed pharmacological VTE prophylaxis in TBI patients. Eligible studies were analyzed using OR and 95% CI in a NMA with MetaInsight v6.2.0. Results Fourteen studies (13,173 patients) were included in the NMA. The results suggest that pharmacological VTE prophylaxis initiated within 24 to 48 hours significantly reduced the risks of deep vein thrombosis (DVT) [OR 0.94, 95% CI: 0.20 to 4.41; SUCRA: 81.33], pulmonary embolism (PE) [OR 0.11, 95% CI: 0.01 to 0.89; SUCRA: 81.33], and ICH progression [OR 0.49, 95% CI: 0.25 to 0.98; SUCRA: 81.33]. However, no statistically significant differences were observed in the overall incidence of mortality and VTE across all time intervals. Notably, the 24-48 hour window demonstrated the highest effectiveness, as reflected by its SUCRA value of 81.33% for mortality and VTE outcomes. Conclusions Pharmacological VTE prevention initiated within 24 to 48 hours reduces DVTs, PE, and ICH development in TBI patients, emphasizing the significance of prompt management while balancing concerns about worsening ICH. Further study is needed to improve VTE prophylaxis timing and safety in this patient population. Conflict of interest nada ahmed. nothing to disclose, Wesal Mahmoud. nothing to disclose, Alyaa Madeeh. nothing to disclose