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Heparin for prophylaxis of venous thromboembolism in intracerebral haemorrhage

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...

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Main Authors: Sprügel, Maximilian Immanuel (Author) , Sembill, Jochen A. (Author) , Kuramatsu, Joji B. (Author) , Gerner, Stefan T. (Author) , Hagen, Manuel (Author) , Roeder, Sebastian S. (Author) , Endres, Matthias (Author) , Haeusler, Karl Georg (Author) , Sobesky, Jan (Author) , Schurig, Johannes (Author) , Zweynert, Sarah (Author) , Bauer, Miriam (Author) , Vajkoczy, Peter (Author) , Ringleb, Peter A. (Author) , Purrucker, Jan (Author) , Rizos, Timolaos (Author)
Format: Article (Journal)
Language:English
Published: 16 April 2019
In: Journal of neurology, neurosurgery, and psychiatry
Year: 2019, Volume: 90, Issue: 7, Pages: 783-791
ISSN:1468-330X
DOI:10.1136/jnnp-2018-319786
Online Access:Verlag, Volltext: https://doi.org/10.1136/jnnp-2018-319786
Verlag, Volltext: https://jnnp.bmj.com/content/90/7/783
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Author Notes:Maximilian I Sprügel, Jochen A Sembill, Joji B Kuramatsu, Stefan T Gerner, Manuel Hagen, Sebastian S Roeder, Matthias Endres, Karl Georg Haeusler, Jan Sobesky, Johannes Schurig, Sarah Zweynert, Miriam Bauer, Peter Vajkoczy, Peter Arthur Ringleb, Jan Christoph Purrucker, Timolaos Rizos, Jens Volkmann, Wolfgang Muellges, Peter Kraft, Anna-Lena Schubert, Frank Erbguth, Martin Nueckel, Peter D Schellinger, Jörg Glahn, Ulrich J Knappe, Gereon Rudolf Fink, Christian Dohmen, Henning Stetefeld, Anna Lena Fisse, Jens Minnerup, Georg Hagemann, Florian Rakers, Heinz Reichmann, Hauke Schneider, Sigrid Wöpking, Albert C Ludolph, Sebastian Stösser, Hermann Neugebauer, Joachim Röther, Peter Michels, Michael Schwarz, Gernot Reimann, Hansjörg Bäzner, Henning Schwert, Joseph Classen, Dominik Michalski, Armin Grau, Frederick Palm, Christian Urbanek, Johannes C Wöhrle, Fahid Alshammari, Markus Horn, Dirk Bahner, Otto W Witte, Albrecht Guenther, Gerhard F Hamann, Hannes Lücking, Arnd Dörfler, Stefan Schwab, Hagen B Huttner
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Summary: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.
Item Description:Gesehen am 05.12.2019
Physical Description:Online Resource
ISSN:1468-330X
DOI:10.1136/jnnp-2018-319786

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