Safety of Subcutaneous Heparin in Patients Requiring External Ventricular Drains.

BACKGROUND AND OBJECTIVES: External ventricular drain (EVD) placement and removal to manage intracranial pressure carry an inherent risk of hemorrhage, which complicates chemoprophylactic management of venous thromboembolism (VTE). VTE chemoprophylaxis with subcutaneous (SQ) heparin is effective in preventing deep venous thrombosis; however, administration to patients with EVDs may exacerbate hemorrhage risk. We assessed the risk of hemorrhage with SQ heparin administration in patients who received EVDs. METHODS: One hundred twenty patients who underwent EVD placement received chemoprophylactic treatment for VTE with SQ heparin and were assessed for EVD tract intraparenchymal hemorrhage (IPH). RESULTS: Of the 161 EVDs placed in patients receiving SQ heparin, EVD tract IPH occurred in 16 (9.94%) EVD placements. Patients who began SQ heparin before the procedure did not exhibit a higher rate of IPH than patients who initiated on SQ heparin shortly after placement. CONCLUSION: SQ heparin seems to be safe for chemoprophylactic management of VTE in patients with EVDs.