Abstract WP278: Is Prophylactic Anticoagulation For Deep Venous Thrombosis Common Practice After Intracerebral Hemorrhage?
Background: Prior studies suggest that early initiation of prophylactic anticoagulation for deep venous thrombosis (DVT) is safe after intracerebral hemorrhage (ICH). Current guidelines recommend considering prophylactic anticoagulation after cessation of hematoma growth and as early as 2 days after onset.
Methods: From the Premier database, a representative sample of approximately 15% of US hospital discharges and containing pharmacy records, we identified adult patients with ICH (primary/admitting ICD-9 code 431) who survived to day 2. We excluded those who underwent craniotomy or angiography. We abstracted type of anticoagulant used and date of first administration. We employed univariable statistics and multivariable logistic regression to assess patient and hospital factors associated with receiving prophylactic anticoagulation after ICH.
Results: From 2006 to 2010, 33,858 patients met our inclusion and exclusion criteria. Overall, 6,018 (17.8%) received any prophylactic anticoagulation during the hospital stay. Among these patients, 66% received prophylactic anticoagulation by day 2 and 76% had received an initial dose by day 6. The most commonly used agents were as follows: heparin (70.2%), enoxaparin (28.6%), and dalteparin (1.3%). The proportion of patients receiving prophylactic anticoagulation and the proportion of those receiving it within 2 days did not change over the study period. Use of prophylactic anticoagulation varied by geographic region (P<0.001) in the US: Northeast (24.7%), South (20.3%), Midwest (12.1%), and West (10.7%). In multivariable analysis (Table), geographic region remained an independent predictor of prophylactic anticoagulation.
Conclusions: Less than 20% of ICH patients receive anticoagulation for DVT in the United States. When utilized, the time to initiation is < 2 days in the majority of patients. Further study should focus on understanding variations in practice and emphasize guideline-driven care.
- © 2012 by American Heart Association, Inc.