Abstract W MP30: Safety of Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Patients With Aneurysmal Subarachnoid Hemorrhage
Background: Venous thrombo-embolism (VTE) is common in patients admitted to intensive care units. The incidence of VTE in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) varies from 1.5 to 18%, depending on the series and the screening strategy. There is limited data addressing the role of chemical prophylaxis in the aSAH population. Our institutional guidelines suggest VTE prophylaxis with sequential compression pneumatic devices prior to securing a ruptured intracranial aneurysm. Unfractionated heparin (UFH) at a dose of 5,000 IU (SC every 12 h) is considered after the aneurysm has been secured for 24 hours.
Methods: We retrospectively reviewed data from all aSAH patients admitted to a 19-bed high volume aSAH ICU, between January 2013 and June 2013.
Results: Fifty-two patients with aSAH (mean age 58.6, range 28-93) were admitted during the study period. In total, 61 aneurysms were found, 46 ruptured, and additional 10 incidentally discovered aneurysm. 72.1% of aSAH patients received UFH after aneurysm treatment. In the 26.9% of patients UFH was withheld; these patients had either unsecured aneurysms or withdrawal of life-sustaining treatments. Of the patients who received UFH 48.7% received the medication at 24h after aneurysm treatment, 33.5% within 72h; and in 15.4% heparin was started beyond 72h after aneurysm treatment. The mean time from aneurysm treatment to initiation of VTE prophylaxis was 2.1 days. Of those patients who received UFH, 22 patients (58%) had an External Ventricular Drain. Endovascular treatment was the main modality as compared to surgical clipping (61.5 vs 15.4%). 6 patients (11.5%) received prophylactic dose of UFH and dual antiplatelets therapy (aspirin and clopidogrel). 1 patient (2%) who was on UFH had a major cerebral hemorrhagic complication and died, however, this patient was also on aspirin and clopidogrel. 8 patients (21%) were investigated for clinical suspicion of VTE; 1 patient (2%) on UFH had a pulmonary embolism.
Conclusion: The use of subcutaneous UFH for VTE prophylaxis after 24h of aneurysm treatment is feasible, safe, and effective in an aSAH population. Caution should be taken in patients receiving subcutaneous UFH and antiplatelet agents, in whom the risk of intra-cerebral bleeding is higher.
Author Disclosures: A.L.D. Manoel: None. A. Goffi: None. D. Turkel-Parrella: None. V. McCredie: None. D. Ben-Israel: None. S. Abrahamson: None.
- © 2014 by American Heart Association, Inc.