Heparin for prophylaxis of venous thromboembolism in intracerebral haemorrhage. Issue 7 (16th April 2019)

• Record Type: Journal Article
• Authors: Sprügel, Maximilian I; Sembill, Jochen A; Kuramatsu, Joji B; Gerner, Stefan T; Hagen, Manuel; Roeder, Sebastian S; Endres, Matthias; Haeusler, Karl Georg; Sobesky, Jan; Schurig, Johannes; Zweynert, Sarah; Bauer, Miriam; Vajkoczy, Peter; Ringleb, Peter Arthur; Purrucker, Jan Christoph; Rizos, Timolaos; Volkmann, Jens; Muellges, Wolfgang; Kraft, Peter; Schubert, Anna-Lena; Erbguth, Frank; Nueckel, Martin; Schellinger, Peter D; Glahn, Jörg; Knappe, Ulrich J; Fink, Gereon Rudolf; Dohmen, Christian; Stetefeld, Henning; Fisse, Anna Lena; Minnerup, Jens; Hagemann, Georg; Rakers, Florian; Reichmann, Heinz; Schneider, Hauke; Wöpking, Sigrid; Ludolph, Albert C; Stösser, Sebastian; Neugebauer, Hermann; Röther, Joachim; Michels, Peter; Schwarz, Michael; Reimann, Gernot; Bäzner, Hansjörg; Schwert, Henning; Classen, Joseph; Michalski, Dominik; Grau, Armin; Palm, Frederick; Urbanek, Christian; Wöhrle, Johannes C; Alshammari, Fahid; Horn, Markus; Bahner, Dirk; Witte, Otto W; Guenther, Albrecht; Hamann, Gerhard F; Lücking, Hannes; Dörfler, Arnd; Schwab, Stefan; Huttner, Hagen B;
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 90:Issue 7(2019)
• Page Start: 783
• Page End: 791
• Publication Date: 2019-04-16
• Subjects: intracerebral heamorrhage -- cerebrovascular disease -- stroke -- critical care; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2018-319786
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objective: To determine the occurrence of intracranial haemorrhagic complications (IHC) on heparin prophylaxis (low-dose subcutaneous heparin, LDSH) in primary spontaneous intracerebral haemorrhage (ICH) (not oral anticoagulation-associated ICH, non-OAC-ICH), vitamin K antagonist (VKA)-associated ICH and non-vitamin K antagonist oral anticoagulant (NOAC)-associated ICH. Methods: Retrospective cohort study (RETRACE) of 22 participating centres and prospective single-centre study with 1702 patients with VKA-associated or NOAC-associated ICH and 1022 patients with non-OAC-ICH with heparin prophylaxis between 2006 and 2015. Outcomes were defined as rates of IHC during hospital stay among patients with non-OAC-ICH, VKA-ICH and NOAC-ICH, mortality and functional outcome at 3 months between patients with ICH with and without IHC. Results: IHC occurred in 1.7% (42/2416) of patients with ICH. There were no differences in crude incidence rates among patients with VKA-ICH, NOAC-ICH and non-OAC-ICH (log-rank p=0.645; VKA-ICH: 27/1406 (1.9%), NOAC-ICH 1/130 (0.8%), non-OAC-ICH 14/880 (1.6%); p=0.577). Detailed analysis according to treatment exposure (days with and without LDSH) revealed no differences in incidence rates of IHC per 1000 patient-days (LDSH: 1.43 (1.04–1.93) vs non-LDSH: 1.32 (0.33–3.58), conditional maximum likelihood incidence rate ratio: 1.09 (0.38–4.43); p=0.953). Secondary outcomes showed differences in functional outcome (modified Rankin Scale=4–6: IHC: 29/37 (78.4%) vs non-IHC: 1213/2048 (59.2%); p=0.019) and mortality (IHC: 14/37 (37.8%) vs non-IHC: 485/2048 (23.7%); p=0.045) in disfavour of patients with IHC. Small ICH volume (OR: volume <4.4 mL: 0.18 (0.04–0.78); p=0.022) and low National Institutes of Health Stroke Scale (NIHSS) score on admission (OR: NIHSS <4: 0.29 (0.11–0.78); p=0.014) were significantly associated with fewer IHC. Conclusions: Heparin administration for venous thromboembolism (VTE) prophylaxis in patients with ICH appears to be safe regarding IHC among non-OAC-ICH, VKA-ICH and NOAC-ICH in this observational cohort analysis. Randomised controlled trials are needed to verify the safety and efficacy of heparin compared with other methods for VTE prevention.