Key result
Low-dose intravenous heparin infusion significantly reduced the risk of cerebral infarction compared to standard subcutaneous heparin (9% vs 18%; OR 0.40, 95% CI 0.23-0.71) in patients after aSAH.
Why the study?
Patients surviving aneurysmal subarachnoid hemorrhage remain at risk for delayed neurological deficits and cerebral infarction, prompting evaluation of the safety and efficacy of low-dose intravenous heparin.
Does low-dose intravenous heparin infusion reduce delayed neurological deficits and cerebral infarction in patients with aneurysmal subarachnoid hemorrhage?
Cohort (n=556)
No
Does low-dose intravenous heparin infusion reduce delayed neurological deficits and cerebral infarction in patients with aneurysmal subarachnoid hemorrhage?
Answers are grounded in this paper and cite their sources.
Low-dose intravenous heparin infusion may reduce the risk of delayed neurological deficits and cerebral infarction in patients with aneurysmal subarachnoid hemorrhage without increasing hemorrhagic complications.
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.
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Kole et al. (2020) conducted a cohort in aneurysmal subarachnoid hemorrhage (aSAH) (n=556). low-dose intravenous heparin (LDIVH) infusion vs. standard subcutaneous heparin (SQH) prophylaxis was evaluated on cerebral infarction (OR 0.40, 95% CI 0.23, 0.71, p=.004). Low-dose intravenous heparin infusion significantly reduced the risk of cerebral infarction compared to standard subcutaneous heparin (9% vs 18%; OR 0.40, 95% CI 0.23-0.71) in patients after aSAH.
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