Heparin for prophylaxis of venous thromboembolism in intracerebral haemorrhage.
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Sprügel Maximilian I, Sembill Jochen A, Kuramatsu Joji B, Gerner Stefan T, Hagen Manuel, Roeder Sebastian S, Endres Matthias, Haeusler Karl Georg, Sobesky Jan, Schurig Johannes, Zweynert Sarah, Bauer Miriam, Vajkoczy Peter, Ringleb Peter Arthur, Purrucker Jan Christoph, Rizos Timolaos, Volkmann Jens, Muellges Wolfgang, Kraft Peter, Schubert Anna-Lena, Erbguth Frank, Nueckel Martin, Schellinger Peter D, Glahn Jörg, Knappe Ulrich J, Fink Gereon Rudolf, Dohmen Christian, Stetefeld Henning, Fisse Anna Lena, Minnerup Jens, Hagemann Georg, Rakers Florian, Reichmann Heinz, Schneider Hauke, Wöpking Sigrid, Ludolph Albert C, Stösser Sebastian, Neugebauer Hermann, Röther Joachim, Michels Peter, Schwarz Michael, Reimann Gernot, Bäzner Hansjörg, Schwert Henning, Classen Joseph, Michalski Dominik, Grau Armin, Palm Frederick, Urbanek Christian, Wöhrle Johannes C, Alshammari Fahid, Horn Markus, Bahner Dirk, Witte Otto W, Guenther Albrecht, Hamann Gerhard F, Lücking Hannes, Dörfler Arnd, Schwab Stefan, Huttner Hagen B
Аннотация
METHODS: Retrospective cohort study (RETRACE) of 22 participating centres and prospective single-centre study with 1702 patients with VKA-associated or NOAC-associated ICH and 1022 patients with non-OAC-ICH with heparin prophylaxis between 2006 and 2015. Outcomes were defined as rates of IHC during hospital stay among patients with non-OAC-ICH, VKA-ICH and NOAC-ICH, mortality and functional outcome at 3 months between patients with ICH with and without IHC.
RESULTS: IHC occurred in 1.7% (42/2416) of patients with ICH. There were no differences in crude incidence rates among patients with VKA-ICH, NOAC-ICH and non-OAC-ICH (log-rank p=0.645; VKA-ICH: 27/1406 (1.9%), NOAC-ICH 1/130 (0.8%), non-OAC-ICH 14/880 (1.6%); p=0.577). Detailed analysis according to treatment exposure (days with and without LDSH) revealed no differences in incidence rates of IHC per 1000 patient-days (LDSH: 1.43 (1.04-1.93) vs non-LDSH: 1.32 (0.33-3.58), conditional maximum likelihood incidence rate ratio: 1.09 (0.38-4.43); p=0.953). Secondary outcomes showed differences in functional outcome (modified Rankin Scale=4-6: IHC: 29/37 (78.4%) vs non-IHC: 1213/2048 (59.2%); p=0.019) and mortality (IHC: 14/37 (37.8%) vs non-IHC: 485/2048 (23.7%); p=0.045) in disfavour of patients with IHC. Small ICH volume (OR: volume <4.4 mL: 0.18 (0.04-0.78); p=0.022) and low National Institutes of Health Stroke Scale (NIHSS) score on admission (OR: NIHSS <4: 0.29 (0.11-0.78); p=0.014) were significantly associated with fewer IHC.
CONCLUSIONS: Heparin administration for venous thromboembolism (VTE) prophylaxis in patients with ICH appears to be safe regarding IHC among non-OAC-ICH, VKA-ICH and NOAC-ICH in this observational cohort analysis. Randomised controlled trials are needed to verify the safety and efficacy of heparin compared with other methods for VTE prevention.