Low-Dose Intravenous Heparin Infusion After Aneurysmal Subarachnoid Hemorrhage is Associated With Decreased Risk of Delayed Neurological Deficit and Cerebral Infarction.

Abstract

BACKGROUND:

Patients who survive aneurysmal subarachnoid hemorrhage (aSAH) are at risk for delayed neurological deficits (DND) and cerebral infarction. In this exploratory cohort comparison analysis, we compared in-hospital outcomes of aSAH patients administered a low-dose intravenous heparin (LDIVH) infusion (12 U/kg/h) vs those administered standard subcutaneous heparin (SQH) prophylaxis for deep vein thrombosis (DVT; 5000 U, 3 × daily).

OBJECTIVE:

To assess the safety and efficacy of LDIVH in aSAH patients.

METHODS:

We retrospectively analyzed 556 consecutive cases of aSAH patients whose aneurysm was secured by clipping or coiling at a single institution over a 10-yr period, including 233 administered the LDIVH protocol and 323 administered the SQH protocol. Radiological and outcome data were compared between the 2 cohorts using multivariable logistic regression and propensity score-based inverse probability of treatment weighting (IPTW).

RESULTS:

The unadjusted rate of cerebral infarction in the LDIVH cohort was half that in SQH cohort (9 vs 18%; P = .004). Multivariable logistic regression showed that patients in the LDIVH cohort were significantly less likely than those in the SQH cohort to have DND (odds ratio (OR) 0.53 [95% CI: 0.33, 0.85]) or cerebral infarction (OR 0.40 [95% CI: 0.23, 0.71]). Analysis following IPTW showed similar results. Rates of hemorrhagic complications, heparin-induced thrombocytopenia and DVT were not different between cohorts.

CONCLUSION:

This cohort comparison analysis suggests that LDIVH infusion may favorably influence the outcome of patients after aSAH. Prospective studies are required to further assess the benefit of LDIVH infusion in patients with aSAH.

• Authors: Matthew J Kole, Aaron P Wessell, Beatrice Ugiliweneza, Gregory J Cannarsa, Enzo Fortuny, Jesse A Stokum, Phelan Shea, Timothy Chryssikos, Nicolas K Khattar, George A Crabill, David L Schreibman, Neeraj Badjatia, Dheeraj Gandhi, E Francois Aldrich, Robert F James, J Marc Simard
• Journal: Neurosurgery (Neurosurgery) Vol. 88 Issue 3 Pg. 523-530 (02 16 2021) ISSN: 1524-4040 [Electronic] United States
• PMID: 33269390 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 by the Congress of Neurological Surgeons.

Chemical References

• Anticoagulants
• Heparin

Topics

• Adult
• Aged
• Anticoagulants (administration & dosage)
• Cerebral Infarction (diagnostic imaging, etiology, prevention & control)
• Cohort Studies
• Female
• Heparin (administration & dosage)
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Nervous System Diseases (diagnostic imaging, etiology, prevention & control)
• Prospective Studies
• Retrospective Studies
• Risk Factors
• Subarachnoid Hemorrhage (complications, diagnostic imaging, drug therapy)