In severe TBI, what is the recommended approach to DVT prophylaxis?

• A. Pharmacologic prophylaxis started immediately.
• B. Never.
• C. Combined pharmacologic prophylaxis with mechanical prophylaxis early.
• D. One week after.

Answer: (C)

In severe traumatic brain injury, preventing DVT requires both stopping venous stasis now and reducing clotting risk as soon as it’s safe. Mechanical prophylaxis, like sequential compression devices, should be started immediately to promote blood flow in the legs. Pharmacologic prophylaxis, using low-dose heparin or LMWH, should be added as soon as imaging shows the intracranial bleed is stable and not expanding, typically within the first 24 to 72 hours depending on the situation. Using these approaches together early provides the best protection against DVT and PE without substantially raising the risk of worsening intracranial hemorrhage. Delaying pharmacologic prophylaxis or avoiding it altogether leaves patients at higher risk for clots, while starting pharmacologic prophylaxis too early without stability increases bleeding risk.