Comparative Study of Venous Thromboembolic Prophylaxis Strategies for Patients with Ischemic Stroke: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Venous thromboembolism (VTE), including deep vein thrombosis (DVT), and pulmonary embolism (PE), is a common complication in patients with ischemic stroke. Several prophylactic strategies are used to reduce the risk of VTE. However, there is still a lack of consensus on the optimal strategy due to the lack of randomized controlled trials (RCTs) directly comparing different interventions. The objective of this study was to explore the efficacy and safety of different thromboembolic prophylaxis strategies in patients with ischemic stroke. We conducted a systematic literature review to identify all eligible RCTs, searching MEDLINE and Embase up to December 31, 2024. We considered DVT and PE as efficacy outcomes and intracranial and extracranial hemorrhage as safety outcome measures. Relevant data were extracted for network meta-analyses. A random-effects model was used for the analysis. A total of 33 RCTs were included in the analysis. Network meta-analysis revealed that low-molecular-weight heparin (LMWH) and heparinoid were associated with significantly decreased risk of DVT and PE compared with no prophylaxis, with risk ratios of 0.18 (95% confidence interval: 0.10-0.32) and 0.36 (0.20-0.63), respectively. However, LMWH and heparinoid were associated with an increased risk of extracranial hemorrhage compared with no prophylaxis, with a risk ratio of 2.03 (1.24-3.34). Our study supports the use of LMWH and heparinoid as the primary thromboembolic prophylaxis measure in patients with acute ischemic stroke. Further, high-quality RCTs are needed to strengthen the evidence base and determine the optimal prophylactic strategy in these patients.