Before initiating pharmacologic DVT prophylaxis in traumatic brain injury, what condition should be confirmed?

• A. It is safe to administer (no active bleeding and stable ICP)
• B. The patient has fever
• C. The patient has normal glucose
• D. The patient has elevated blood pressure

Answer: (A)

Before starting pharmacologic DVT prophylaxis in a traumatic brain injury patient, you must confirm there is no active intracranial bleeding and that intracranial pressure is stable. Anticoagulants can worsen an existing bleed or cause hematoma expansion, leading to worse outcomes. If imaging shows ongoing bleeding or ICP is unstable, delaying pharmacologic prophylaxis or using alternative, non-pharmacologic methods is safer. Fever, normal glucose, or elevated blood pressure by themselves do not determine the safety of starting prophylaxis; they require separate management, but do not replace the need to verify that there is no active bleed and that ICP is controlled.