Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the most feared complication in patients suffering from spontaneous intracerebral hemorrhage (ICH). The balance between VTE risk and the risk of hematoma expansion and/or re-bleeding is the cornerstone of prophylaxis which is based on non-pharmacological and pharmacological strategies. In the latest years results of three randomized clinical trials on non-pharmacological prophylaxis in ischemic and hemorrhagic stroke have been published. Intermittent pneumatic compression has shown to be effective in ICH compared to placebo, whereas graduated compression stockings failed to show their superiority over placebo. Few and low quality studies reported on pharmacological prophylaxis in ICH. Overall, these studies showed that pharmacological prophylaxis could be safe, but whether it is more effective than other non-pharmacological methods remains unclear. A meta-analysis of four randomized controlled studies showed that pharmacological prophylaxis significantly reduces the rate of pulmonary embolism. Consequently, recommendations from Scientific Societies for VTE prevention in ICH are based on weak literature evidence. In the present article, the Authors provide a review on VTE prevention in ICH and propose a practical algorithm for clinical management of this topic.
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