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(Stroke. 2003;34:2999.)
© 2003 American Heart Association, Inc.

Comments, Opinions, and Reviews

Anticoagulation or Inferior Vena Cava Filter Placement for Patients With Primary Intracerebral Hemorrhage Developing Venous Thromboembolism?

From Elderly Care/GIM Elderly Care Department, St Thomas’ Hospital, London, UK.

Correspondence to Dr J. Kelly, Elderly Care/GIM Elderly Care Department, North Wing (9th Floor), St Thomas’ Hospital, Lambeth Palace Rd, Lambeth, London SE1 7EH UK. E-mail jameskelly{at}northbrookfm.fsnet.co.uk

Background— Most patients with primary intracerebral hemorrhage developing clinically apparent proximal deep vein thrombosis (DVT) and/or pulmonary embolism (PE) require treatment with either anticoagulants or inferior vena cava filter insertion. Although the latter probably reduces the immediate risk of incident or recurrent PE and surmounts the undefined risk of recurrent intracranial bleeding with anticoagulation, the issue of preventing further thrombus propagation is not addressed, and there are associated short- and long-term risks, including a greater incidence of recurrent DVT.

Summary of Review— There are no data from randomized trials to clarify optimum treatment in these patients; indeed, the feasibility of such studies is questionable. Hence, treatment decisions continue to be made on an individualized basis and should include assimilation of information on key factors such as time elapsed post-stroke and lobar versus deep hemispheric location of the index event, natural history studies demonstrating a two-fold risk of recurrent intracerebral hemorrhage in the former subgroup.

Conclusions— In patients selected for anticoagulation, data from nonstroke patients suggest that a 5- to 10-day course of full-dose low-molecular-weight heparin followed by 3 months of lower-dose low-molecular-weight heparin is at least as effective as warfarin and may be associated with fewer hemorrhagic complications.

Key Words: deep vein thrombosis • intracerebral hemorrhage • pulmonary embolism

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