Abstract W MP113: Type and Timing of Venous Thromboembolism Prophylaxis after Intracerebral Hemorrhage
INTRODUCTION: Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality after intracerebral hemorrhage (ICH). Guidelines encourage the early use of mechanical and chemo prophylaxis (CP; i.e., low-dose heparin or low-molecular weight heparin) after ICH. We sought to determine the type and timing, temporal trends, and patient and hospital characteristics associated with VTE prophylaxis after ICH in the Get With the Guidelines-Stroke registry.
METHODS: We identified patients with ICH between January 1, 2009 and September 30, 2013 who: 1) were not ambulatory and/or comfort care measures only by hospital day 2; 2) were not transferred to another acute care facility; and 3) had known VTE prophylaxis status at end of hospital day 2. Categories for VTE prophylaxis were 1) no prophylaxis, 2) mechanical prophylaxis alone or unknown/other prophylaxis, or 3) CP with or without mechanical prophylaxis. Early VTE prophylaxis was defined as occurring by hospital day 2. Using multivariable logistic regression, we assessed patient, hospital, and geographic factors associated with early CP use.
RESULTS: Among 81,828 patients with ICH from 1,450 hospitals, 5929 (7.2%) received early CP; 68,205 (83.4%) received early mechanical prophylaxis only or other/unknown type; and 7,694 (9.4%) had no early prophylaxis. There was no increase in CP use over the study period. In multivariable analysis, several patient, hospital, and geographic factors were independently associated with early versus no early CP use (Table).
CONCLUSIONS: Nationwide, the large majority of ICH patients receive early VTE prophylaxis with mechanical devices only, without prophylactic anticoagulants. Hospital characteristics such as size and geographic location are strong determinants of increased early prophylactic anticoagulant use. Further study of practice variation is needed.
Author Disclosures: L.J. Cherian: None. E. Smith: None. L. Schwamm: None. G. Fonarow: None. Y. Xian: None. J. Wu: None. S. Prabhakaran: None.
- © 2015 by American Heart Association, Inc.