The grades of evidence (I-III) and levels of recommendations (I-III) are defined at the end of the "Major Recommendations" field.
Level I
There are insufficient data to support a Level I recommendation for this topic.
Level II
There are insufficient data to support Level II recommendation for this topic.
Level III
Graduated compression stockings or intermittent pneumatic compression (IPC) stockings are recommended, unless lower extremity injuries prevent their use. Use should be continued until patients are ambulatory.
Low molecular weight heparin (LMWH) or low dose unfractionated heparin should be used in combination with mechanical prophylaxis. However, there is an increased risk for expansion of intracranial hemorrhage.
There is insufficient evidence to support recommendations regarding the preferred agent, dose, or timing of pharmacologic prophylaxis for deep vein thrombosis (DVT).
Summary
Level III evidence supports the use of graduated compression or IPC stockings placed for DVT prophylaxis for patients with severe traumatic brain injury (TBI), unless lower extremity injuries prevent their use. Level III evidence supports the use of prophylaxis with low-dose heparin or LMWH for prevention of DVT in patients with severe TBI. However, no reliable data can support a recommendation regarding when it is safe to begin pharmacological prophylaxis. Moreover, no recommendations can be made regarding medication choice or optimal dosing regimen for patients with severe TBI, based on the current evidence.
Definitions:
Grades of Evidence
Class I - Good quality randomized controlled trial (RCT)
Class II - Moderate quality RCT, good quality cohort, good quality case-control, poor quality RCT
Class III - Moderate or poor quality cohort, moderate or poor case-control, case series, databases or registries
Levels of Recommendation
Levels of recommendation are Level I, II, and III, derived from Class I, II, and III evidence, respectively.
Level I - recommendations are based on the strongest evidence for effectiveness, and represent principles of patient management that reflect a high degree of clinical certainty.
Level II - recommendations reflect a moderate degree of clinical certainty.
Level III - recommendations for which the degree of clinical certainty is not established.