Early pharmacological venous thromboembolism prophylaxis reduces lower limb deep vein thrombosis in surgical patients with severe hypertensive intracerebral hemorrhage: a retrospective cohort study.

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%, 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.