Low-Dose Intravenous Heparin Infusion After Aneurysmal Subarachnoid Hemorrhage is Associated With Decreased Risk of Delayed Neurological Deficit and Cerebral Infarction
| Autor: | Robert F James, Nicolas K Khattar, Dheeraj Gandhi, George A. Crabill, Enzo Fortuny, Beatrice Ugiliweneza, Matthew J Kole, David Schreibman, Jesse A. Stokum, J. Marc Simard, E. Francois Aldrich, Timothy Chryssikos, Phelan Shea, Neeraj Badjatia, Aaron Wessell, Gregory Cannarsa |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Subarachnoid hemorrhage Infarction Cohort Studies 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans 030212 general & internal medicine Prospective Studies Prospective cohort study Infusions Intravenous Aged Retrospective Studies business.industry Cerebral infarction Heparin Anticoagulants Vasospasm Odds ratio Cerebral Infarction Middle Aged Subarachnoid Hemorrhage medicine.disease Thrombosis Anesthesia Cohort Surgery Female Neurology (clinical) Nervous System Diseases business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgery. 88(3) |
| ISSN: | 1524-4040 |
| Popis: | Background Patients who survive aneurysmal subarachnoid hemorrhage (aSAH) are at risk for delayed neurological deficits (DND) and cerebral infarction. In this exploratory cohort comparison analysis, we compared in-hospital outcomes of aSAH patients administered a low-dose intravenous heparin (LDIVH) infusion (12 U/kg/h) vs those administered standard subcutaneous heparin (SQH) prophylaxis for deep vein thrombosis (DVT; 5000 U, 3 × daily). Objective To assess the safety and efficacy of LDIVH in aSAH patients. Methods We retrospectively analyzed 556 consecutive cases of aSAH patients whose aneurysm was secured by clipping or coiling at a single institution over a 10-yr period, including 233 administered the LDIVH protocol and 323 administered the SQH protocol. Radiological and outcome data were compared between the 2 cohorts using multivariable logistic regression and propensity score-based inverse probability of treatment weighting (IPTW). Results The unadjusted rate of cerebral infarction in the LDIVH cohort was half that in SQH cohort (9 vs 18%; P = .004). Multivariable logistic regression showed that patients in the LDIVH cohort were significantly less likely than those in the SQH cohort to have DND (odds ratio (OR) 0.53 [95% CI: 0.33, 0.85]) or cerebral infarction (OR 0.40 [95% CI: 0.23, 0.71]). Analysis following IPTW showed similar results. Rates of hemorrhagic complications, heparin-induced thrombocytopenia and DVT were not different between cohorts. Conclusion This cohort comparison analysis suggests that LDIVH infusion may favorably influence the outcome of patients after aSAH. Prospective studies are required to further assess the benefit of LDIVH infusion in patients with aSAH. |
| Databáze: | OpenAIRE |
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