Abstract WMP111: Early Venous Thromboembolism Prophylaxis in Patients with External Ventricular Drains Does Not Increase Hemorrhagic Complications
Background: Patients undergoing placement of an external ventricular drain (EVD) are at increased risk of developing venous thromboembolisms (VTEs). Early chemical prophylaxis has shown to decrease VTE rates. However, the risks of bleeding and time of initiation have not been clearly defined in patient populations requiring EVDs.
Purpose: To evaluate the safety and bleeding risks of starting chemical prophylaxis for VTEs within 24 hours of EVD placement compared to the hemorrhage rates in patients who did not receive prophylaxis within 24 hours.
Methods: An IRB approved retrospective review was for performed patients who had an EVD placed with post-procedural imaging at Bellevue Hospital from January 2009 to April 2012. Demographics, diagnosis, coagulation profile, time to VTE prophylaxis and imaging, and occurrences of VTEs were collected. EVD-associated hemorrhages were graded as: Grade 0, no hemorrhage; Grade 1, petechial hyperdensity in proximity to the catheter; Grade 2, 1ml to 15ml volume of hematoma; Grade 3, greater than 15ml or epidural or subdural hematoma; or Grade 4, interventricular hemorrhage or hematoma requiring surgical intervention. Differences between groups were assessed by the Mann-Whitney U test, and a p value of ≤ 0.05 was used to identify significant differences.
Results: One hundred and eleven EVDs were placed in 99 patients. Fifty-six patients received low dose unfractionated heparin (LDUH) within 24 hours of admission (early prophylaxis). Fifty-five patients received LDUH > 24 hours after admission (delayed prophylaxis). There were no statistical differences across all Grades (0 to 4) amongst the early prophylaxis (n= 45, 5, 5, 1, and 0 respectively) versus delayed prophylaxis (n= 46, 4, 1, 1, and 3 respectively) groups (p=0.658). In the early prophylaxis group, 3 VTEs were discovered in 32 of 56 patients who underwent screening for suspected VTEs. In the delayed prophylaxis group, 6 VTEs were discovered in 33 of 55 patients screened for clinically suspected VTEs (p= 0.488).
Conclusion: There were no increases in hemorrhagic complications with starting chemical prophylaxis within 24 hours of EVD placement. Larger randomized controlled trials are needed to assess a possible decrease in VTEs with earlier prophylaxis.
- © 2012 by American Heart Association, Inc.