Key result
Early LMWH linked to ~72% lower DVT risk versus late initiation in severe surgical HICH.
Why the study?
To evaluate the efficacy and safety of early pharmacological venous thromboembolism prophylaxis on the incidence of lower extremity deep vein thrombosis in patients undergoing surgery for severe hypertensive intracerebral hemorrhage.
Does early pharmacological VTE prophylaxis reduce lower extremity deep vein thrombosis in surgical patients with severe hypertensive intracerebral hemorrhage?
Cohort (n=123)
No
Does early pharmacological VTE prophylaxis reduce lower extremity deep vein thrombosis in surgical patients with severe hypertensive intracerebral hemorrhage?
Effect estimate: Adjusted OR 0.28 (95% CI 0.111-0.694)
Absolute Event Rate: 17.5% vs 38.3%
p-value: p=0.006
Early pharmacological VTE prophylaxis (<48 h) in surgical patients with severe hypertensive intracerebral hemorrhage significantly reduces the risk of lower extremity DVT without significantly increasing bleeding or mortality.
May support earlier LMWH to reduce DVT without excess bleeding; hypothesis-generating and leaves open need for RCTs.
Objective To investigate the efficacy and safety of early pharmacological prophylaxis for venous thromboembolism (VTE) on the incidence of lower extremity deep vein thrombosis (DVT) in patients undergoing surgery for severe hypertensive intracerebral hemorrhage (HICH). Methods In this retrospective cohort study, 123 surgical patients with severe HICH admitted between September 2021 and February 2025 were included. Based on the initiation timing of VTE pharmacological prophylaxis (low-molecular-weight heparin calcium, LMWH), patients were categorized into an early group (prophylaxis initiated within <48 h after admission) and a late group (prophylaxis initiated at ≥48 h after admission). To compare the incidence of lower extremity deep vein thrombosis (DVT), intracranial rebleeding, and gastrointestinal bleeding within one week after prophylaxis initiation, as well as the 60-day mortality rate and 60-day modified Rankin Scale (mRS) score, between the two groups. Results The VTE prophylaxis initiation times were (29.06 ± 4.44) hours and (70.27 ± 10.12) hours in the early and late groups, respectively. The incidence of lower extremity DVT was significantly lower in the early group compared to the late group (17.5% vs. 38.3%, p < 0.05). No statistically significant differences were observed between the two groups in the incidence of intracranial rebleeding (9.5% vs. 5.0%), gastrointestinal bleeding (23.8% vs. 21.7%), 60-day mortality (14.3% vs. 11.7%), or 60-day modified Rankin Scale (mRS) score [4 (IQR 2–5) vs. 4 (IQR 2–5)] (all p > 0.05). Conclusion For surgical patients with severe HICH, early postoperative (<48 h) pharmacological VTE prophylaxis was associated with a significantly reduced risk of lower extremity DVT, and no significant increases in intracranial rebleeding, gastrointestinal bleeding, or mortality were observed. However, given the limited sample size and number of events, these safety findings should be interpreted with caution.
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Yang et al. (2026) conducted a cohort in Severe hypertensive intracerebral hemorrhage (HICH) (n=123). Early pharmacological VTE prophylaxis (LMWH <48 h) vs. Late pharmacological VTE prophylaxis (LMWH ≥48 h) was evaluated on Incidence of new-onset lower extremity DVT on day 7 after prophylaxis initiation (Adjusted OR 0.28, 95% CI 0.111-0.694, p=0.006). Early low-molecular-weight heparin prophylaxis (<48 hours) significantly reduced lower extremity deep vein thrombosis (adjusted OR 0.28) compared to late initiation in severe surgical HICH patients.
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