title: Venous thromboembolism prophylaxis in patients with traumatic brain injury: a systematic review.
abstract: OBJECTIVE
  There is considerable practice variation and clinical uncertainty about the choice of prophylaxis for preventing venous thromboembolism in patients with traumatic brain injury. We performed a systematic review to assess both the effectiveness and safety of pharmacologic and mechanical prophylaxis, and the optimal time to initiate pharmacologic prophylaxis in hospitalized patients with traumatic brain injury.
  
  
  METHODS
  MEDLINE®, EMBASE®, SCOPUS, CINAHL, International Pharmaceutical Abstracts, clinicaltrial.gov, and the Cochrane Library were searched in July 2012 to identify randomized controlled trials and observational studies reporting on the effectiveness or safety of venous thromboembolism prevention in traumatic brain injury patients.
  
  
  METHODS
  Paired reviewers extracted detailed information from included articles on standardized forms and assessed the risk of bias in each article.
  
  
  RESULTS
  Twelve studies (2 randomized controlled trials and 10 cohort studies) evaluated the effectiveness and safety of venous thromboembolism prophylaxis in patients with traumatic brain injury. Five of the included studies assessed the optimal timing of initiation of pharmacological prophylaxis. Low grade evidence supports the effectiveness of enoxaparin over control in reducing deep vein thrombosis. Low grade evidence also supports the safety of unfractionated heparin over control in reducing mortality in patients with traumatic brain injury. Evidence was insufficient for remaining comparisons and outcomes including the optimal timing of initiation of pharmacoprophylaxis.
  
  
  CONCLUSIONS
  There is some evidence that pharmacoprophylaxis improves deep vein thromboses and mortality outcomes in patients hospitalized with traumatic brain injury. Additional studies are required to strengthen this evidence base.
authors.affiliation: John Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
authors.forename: Yohalakshmi
authors.initials: Y
authors.lastname: Chelladurai
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
authors.forename: Kent A
authors.initials: KA
authors.lastname: Stevens
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Brotman
authors.affiliation: John Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
authors.forename: Ritu
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Pharmacy, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Shermock
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
authors.forename: Sosena
authors.initials: S
authors.lastname: Kebede
authors.affiliation: John Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
authors.forename: Sonal
authors.initials: S
authors.lastname: Singh
authors.affiliation: John Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
authors.forename: Jodi B
authors.initials: JB
authors.lastname: Segal