• Neurosurgery · Feb 2021

    Low-Dose Intravenous Heparin Infusion After Aneurysmal Subarachnoid Hemorrhage is Associated With Decreased Risk of Delayed Neurological Deficit and Cerebral Infarction.

    • Matthew J Kole, Aaron P Wessell, Beatrice Ugiliweneza, Gregory J Cannarsa, Enzo Fortuny, Jesse A Stokum, Phelan Shea, Timothy Chryssikos, Nicolas K Khattar, George A Crabill, David L Schreibman, Neeraj Badjatia, Dheeraj Gandhi, E Francois Aldrich, Robert F James, and J Marc Simard.
    • Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.
    • Neurosurgery. 2021 Feb 16; 88 (3): 523-530.

    BackgroundPatients 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).ObjectiveTo assess the safety and efficacy of LDIVH in aSAH patients.MethodsWe 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).ResultsThe 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.ConclusionThis 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.Copyright © 2020 by the Congress of Neurological Surgeons.

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