Timing of pharmacological thromboprophylaxis in severe traumatic brain injury: a systematic review and meta-analysis.

What was studied

This review looked at adults with a severe brain injury after trauma. These people can get blood clots in their veins. Bleeding inside the skull can also get worse in them. The team asked when to start drugs that guard against clots. They pooled results from earlier studies, comparing an early start with a late one. In all, 6,825 people were included.

What they found

Starting the drugs earlier was linked to fewer blood clots. But this link was weak and only just passed the usual test of proof. It did not hold when either of the large studies was left out. It also failed when worked out with another common method. Deaths in hospital did not differ between early and late starts. Only one study checked whether brain bleeding got worse. It had very few such cases, so it gave no clear answer. How often clots were found depended on how closely doctors looked for them.

What it means for patients

The authors say an earlier start may go with fewer clots. An early start did not seem to change the risk of dying in hospital. This fits with past reviews that mixed mild and severe cases. Still, the authors call the result fragile. Whether an early start is safe for brain bleeding is still not known.

Why it is not certain yet

Trust in the evidence was rated very low for all main results. Some studies had a serious risk of bias, and others a moderate one. The studies used different cut-offs for "early" and "late". Brain bleeding was judged by a rough look at scans. This way of checking can miss small or moderate growth. The authors say large randomised trials with exact bleeding measures are needed.

Source

Timing of pharmacological thromboprophylaxis in severe traumatic brain injury: a systematic review and meta-analysis.

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