Venous Thromboembolism in Patients with Acute Brain Injury

Abstract

Venous thromboembolism (VTE) represents a significant and unpredictable complication during any hospital stay. Patients with neurological injuries are at a particularly higher risk for such complications. Both prophylaxis and treatment of VTE in these patients present challenging and often controversial topics for intensivists and neurologists. The abundance of research and guidelines available for treating stroke and traumatic brain injury patients has facilitated the prevention and management of thromboembolisms in this subset of patients. On the other hand, patients with aneurysmal subarachnoid hemorrhage can be safely initiated on anticoagulation therapy once the bleeding vessel is secured. However, patients with spontaneous intraparenchymal hemorrhage have traditionally been overlooked in terms of VTE prophylaxis. Given the complexity and variability in clinical presentations, a tailored approach is essential. This involves balancing the risks of thromboembolism against the potential for exacerbating intracranial bleeding. Emerging evidence and evolving guidelines continue to shape best practices, aiming to optimize outcomes for these vulnerable patient populations.