{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:25Z","timestamp":1788415945632,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>The optimal timing of pharmacologic venous thromboembolism (VTE) prophylaxis in intracerebral hemorrhage (ICH) is uncertain. Using a landmark design that classifies exposure only by information available at a fixed time point, we evaluated whether initiation of pharmacologic VTE prophylaxis within 48\u202fh of ICU admission is associated with in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cohort study in the Medical Information Mart for Intensive Care IV (MIMIC-IV v3.1). Adults with non-traumatic ICH admitted to the ICU (2008\u20132019) who were alive and in hospital at a 48-h landmark were included. Exposure was fixed at the landmark: early prophylaxis\u202f=\u202fpharmacologic prophylaxis started \u226448\u202fh; no early prophylaxis\u202f=\u202fnot started by 48\u202fh (comprising later [delayed] initiators and never-treated patients). Time zero and eligibility were ICU admission + 48\u202fh. Inverse probability of treatment weighting (IPTW) adjusted for 17 baseline covariates including the baseline Glasgow Coma Scale (GCS). The primary outcome was in-hospital mortality (a binary outcome, with discharge alive as the competing event); the secondary outcome was coded VTE (binary). Missing GCS was handled by multiple imputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 2,754 ICH ICU patients, 2,407 reached the 48-h landmark and 2,380 formed the analytic cohort (early prophylaxis,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f655; no early prophylaxis,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,725) after excluding 27 receiving therapeutic anticoagulation within 48\u202fh. In-hospital death occurred in 371 patients (early prophylaxis 10.8%, no early prophylaxis 17.4%). After IPTW (17\/17 covariates standardized mean difference &amp;lt;0.1), early prophylaxis was associated with lower in-hospital mortality (adjusted odds ratio [OR] 0.72, 95% confidence interval [CI] 0.55\u20130.94; weighted risk difference \u22124.0%; cause-specific hazard ratio 0.65, 95% CI 0.50\u20130.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003). There was no statistically significant difference in coded VTE (adjusted OR 1.20, 95% CI 0.85\u20131.69;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.31). The association was directionally consistent across most sensitivity analyses\u2014including a model that treated prophylaxis initiation as a time-varying exposure to reduce immortal-time bias (HR 0.61, 95% CI 0.49\u20130.76) and a competing-risk cumulative-incidence analysis\u2014although the 24-h landmark estimate was not statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this landmark cohort, initiation of pharmacologic VTE prophylaxis within 48\u202fh was associated with lower in-hospital mortality without a statistically significant difference in coded VTE. Because key neuroimaging severity measures (hematoma volume, location, intraventricular extension, and expansion) were unavailable, residual confounding by indication cannot be excluded and a causal interpretation is not warranted. Randomized trials are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1849021","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:14:18Z","timestamp":1788412458000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early pharmacologic venous thromboembolism prophylaxis and in-hospital mortality in ICU patients with intracerebral hemorrhage: a landmark, propensity-weighted cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Hongfu","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]},{"name":"Department of Neurosurgery, The Second Affiliated Hospital of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianyong","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Liaocheng People\u2019s Hospital","place":["Liaocheng, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Er","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Second Affiliated Hospital of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e282","DOI":"10.1161\/STR.0000000000000407","article-title":"2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association\/American Stroke Association","volume":"53","author":"Greenberg","year":"2022","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1016\/j.amjcard.2005.07.097","article-title":"Venous thromboembolism in patients with ischemic and hemorrhagic stroke","volume":"96","author":"Skaf","year":"2005","journal-title":"Am J Cardiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1159\/000202006","article-title":"Sex difference in the prevalence of deep-vein thrombosis in Japanese patients with acute intracerebral 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