Current evidence and future directions for prophylactic anticoagulation therapy after severe spontaneous intracerebral hemorrhage: a narrative review.

Patients with spontaneous intracerebral hemorrhage (sICH) are at high risk for venous thromboembolism (VTE), a complication strongly associated with adverse clinical outcomes. While prophylactic anticoagulation has been shown to effectively reduce VTE incidence, significant uncertainty remains regarding its safety and the optimal timing of initiation. This article comprehensively reviews key aspects including anticoagulant selection, patient eligibility, therapeutic time windows, and current clinical challenges. Research gaps persist in defining appropriate anticoagulation strategies according to drug type, initiation timing, and sICH subtypes (e.g., lobar, deep, or amyloid-related hemorrhage). Future efforts should focus on conducting large-scale, multicenter, prospective clinical trials to validate the efficacy and safety of novel anticoagulants. Concurrently, integrating machine learning to develop high-precision risk prediction models, tailoring individualized treatment approaches, and establishing multidisciplinary collaborative research frameworks are essential steps toward advancing the standardization and rationalization of prophylactic anticoagulation in patients with severe sICH.