Controversies around critical care practices have prevailed since time unknown. This includes the management of coagulation status and the administration of thromboprophylaxis (TP). Extensive research remains ongoing in these areas to provide the best possible practice guidelines, especially for the neurocritically ill. Here, this chapter will take you through the different phases of evidence available in the literature concerning this clinically important preventive and therapeutic intervention. The prevention of venous thromboembolism (VTE) in susceptible populations is crucial to improve patient morbidity and mortality. However, TP-induced benefits need careful balancing with its potential complications, which are, in turn, contributory to life-threatening haemorrhage. The evidence-based guideline provided by the Neurocritical Care Society (NCS) provides useful insights to safely reduce the burden of VTE, with the avoidance of its associated complications. We try to provide the best possible solutions to this commonly faced controversy and focus on the possible areas of future research prospects. In this chapter, we delve deep into the controversies of this aspect of patient management and attempt to inform the best approach to patient care in each scenario.