The effectiveness and safety of pharmacological prophylaxis against venous thromboembolism in patients with moderate-to-severe traumatic brain injury: a systematic review and meta-analysis.

Background: Venous thromboembolism (VTE) is a common, potentially fatal complication after traumatic brain injury (TBI). The objective was to evaluate the effectiveness and safety of pharmacologic VTE prophylaxis in moderate-to-severe TBI patients, and its use in hospitals. Data sources: A systematic review of the literature was conducted using Medline, Embase, Central database, Google scholar and the SciELO from 1966 to 2014. Study Selection and Data Extraction All studies providing information on the following variables: use of VTE prophylaxis (both pharmacological and nonpharmacological), initiation of treatment, application of specific protocols, rates of VTE and hemorrhagic progression of the traumatic brain injury on CT scan were included. The random effects model was employed to calculate pooled effect estimates. Heterogeneity among studies was assessed using the Cochran's Q Homogeneity test. A forest plot was constructed and aggregate odds ratio was computed. Potential publication bias was evaluated using funnel plots. Methods and main results A total of twelve retrospective observational studies were identified, totaling 8,747 patients. Six studies (3,325 patients) were used to analyze the safety and five (2,105 patients) to analyze the effectiveness of pharmacological versus non-pharmacological prophylaxis, without considering the timing of treatment. Four studies (1,371 patients) were used to evaluate early versus late pharmacologic prophylaxis, with results favoring early administration (odds ratio [OR], 0.46; 95%CI, 0.24-0.88; p

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