Early chemoprophylaxis for deep venous thrombosis does not increase the risk of hematoma expansion in patients presenting with spontaneous intracerebral hemorrhage

Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. The development of venous thromboembolism (VTE), including deep venous thrombosis or pulmonary embolism, is correlated with negative outcomes following ICH. Due to the risk of hematoma expansion associated with the use of VTE chemoprophylaxis, there remains significant debate about the optimal timing for its initiation following ICH. We analyzed the risk of early chemoprophylaxis on hematoma expansion following ICH. Methods: We performed a retrospective analysis of patients presenting with spontaneous ICH at single institution between 2011 and 2018. The rate of hematoma expansion was compared between patients that received early chemoprophylaxis (on admission) and those that received conventional chemoprophylaxis (>24 h). Results: Data for 235 patients were available for analysis. Eleven patients (7.5%) in the early prophylaxis cohort and seven patients (8.0%) in the conventional prophylaxis cohort developed VTE (P = 0.9). Hematoma expansion also did not differ significantly (early 19%, conventional 23%, P = 0.5). Conclusion: The use of early chemoprophylaxis against venous thromboembolic events following ICH appears safe in our patient population without increasing the risk of hematoma expansion. Given the increased risk of poor outcome in the setting of VTE, early VTE chemoprophylaxis should be considered in patients who present with ICH. Larger, prospective, and randomized studies are necessary to better elucidate the risk of early chemoprophylaxis and potential reduction in venous thromboembolic events.

Venous Thromboembolism Prophylaxis After Spontaneous Intracerebral Hemorrhage

“…9 Based on the difference in study design, 7 cohort studies mainly compared the application of prophylactic anticoagulation therapy with no anticoagulation therapy, 27 prophylactic anticoagulation therapy combined with GCS versus GCS alone, 28 and anticoagulation therapy early (eg, within 24 h) and late (eg, day 10). 26,32,33,35,36 The results of the above studies are consistent with the finding that the incidence of HE in patients with ICH who received pharmacological prophylaxis is similar to that in the control group, even when applied within 24 hours of ICH onset. The same safety (in terms of HE) of direct oral anticoagulants after ICH has also been reported.…”

“…It is worth mentioning that most of these studies found no significant difference in the incidence of VTE between the compared groups. [26][27][28][29]32,34,36,37 This is probably due to the limited number of RCTs and reduced sample size of studies. To better overcome this difficulty, several meta-analyses have been reported.…”