Early heparin therapy in patients with spontaneous intracerebral haemorrhage.

Boeer, A; Voth, E.; Henze, Thomas; Prange, Hilmar

doi:10.1136/jnnp.54.5.466

Cited by 179 publications

(126 citation statements)

References 10 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…[16][17][18][19][20][21] Three small randomized trials have also been completed. [22][23][24] In 68 patients with ICH, low-dose heparin starting on day 2 led to a statistically lower rate of PE when compared with 4th or 10th day of initiation. 24 The second trial included 46 patients and found that low-dose subcutaneous heparin did not increase risk of rebleeding or hematoma expansion.…”

Section: February 2015mentioning

confidence: 99%

“…[22][23][24] In 68 patients with ICH, low-dose heparin starting on day 2 led to a statistically lower rate of PE when compared with 4th or 10th day of initiation. 24 The second trial included 46 patients and found that low-dose subcutaneous heparin did not increase risk of rebleeding or hematoma expansion. 23 A more recent trial of 75 patients using enoxaparin also observed no increase risk of hematoma expansion.…”

Section: February 2015mentioning

confidence: 99%

See 1 more Smart Citation

Is Prophylactic Anticoagulation for Deep Venous Thrombosis Common Practice After Intracerebral Hemorrhage?

Prabhakaran

Herbers

Khoury

et al. 2015

Stroke

View full text Add to dashboard Cite

Background and Purpose— Prophylactic anticoagulation for deep venous thrombosis prevention after intracerebral hemorrhage (ICH) is safe. Current guidelines recommend prophylactic anticoagulation after cessation of hematoma growth. We aimed to evaluate nationwide trends in deep venous thrombosis prophylaxis after ICH. Methods— In an analysis of the Premier database, we identified adult patients with ICH ( International Classification of Diseases Ninth edition code 431) from 2006 to 2010 who survived to day 2 of hospitalization. We excluded those with trauma or who underwent craniotomy or angiography. We abstracted type of anticoagulant used and date of first administration. We used univariate statistics and multivariable logistic regression to assess factors associated with prophylactic anticoagulation after ICH. Results— Among 32 690 (mean age, 69.7 years; 50.1% men) patients with spontaneous ICH, 5395 (16.5%) patients received any prophylactic anticoagulation during the hospital stay. Among these patients, 2416 (44.8%) received prophylactic anticoagulation by day 2. The most commonly used agents were heparin (71.1%), enoxaparin (27.5%), and dalteparin (1.4%). The proportion of patients receiving prophylactic anticoagulation increased slightly during the study period from 14.3% to 18.0% ( P <0.01 for trend). Use of prophylactic anticoagulation varied by geographic region ( P <0.001) in the United States: Northeast (23.2%), South (19.0%), Midwest (10.8%), and West (9.8%). In multivariable analysis, geographic region remained an independent predictor of prophylactic anticoagulation. Conclusions— Less than 20% of patients with ICH receive anticoagulation for deep venous thrombosis in the United States. When used, the time to initiation is <2 days in less than half of the patients. Further study should focus on understanding variations in practice and emphasize guideline-driven care.

show abstract

Section: February 2015mentioning

confidence: 99%

Section: February 2015mentioning

confidence: 99%

Is Prophylactic Anticoagulation for Deep Venous Thrombosis Common Practice After Intracerebral Hemorrhage?

Prabhakaran

Herbers

Khoury

et al. 2015

Stroke

View full text Add to dashboard Cite

show abstract

“…Of the remaining 46 trials, 29 could not be assessed because their eligibility criteria required variables that we had not collected; this left 17 trials whose eligibility criteria were available for analysis (Tables I and II in the online-only Data Supplement), which investigated a variety of treatment strategies including supportive measures, surgery, and hemostatic, neuroprotective, antifibrinolytic or blood pressure-lowering drugs (Table 1; Table III in the online-only Data Supplement). 8,9,[18][19][20][21][22][23][24][25][26][27] …”

Section: Identification Of Trials Of Acute Treatment For Ichmentioning

confidence: 99%

Eligibility for Randomized Trials of Treatments Specifically for Intracerebral Hemorrhage

Fonville

Samarasekera

Hutchison

et al. 2013

Stroke

View full text Add to dashboard Cite

A fter spontaneous (nontraumatic) intracerebral hemorrhage (ICH) more than half of the people affected die within 1 year 1 and half of the survivors are dependent on other people. 2,3 Randomized controlled trials have shown that care on an acute stroke unit is just as beneficial for patients with ICH as it is for their counterparts with ischemic stroke, 4 that surgical evacuation of the ICH may be beneficial for some patients, 5 and that secondary prevention with blood pressure lowering reduces the risk of recurrent stroke. 6 However, a specific treatment for acute ICH is being sought in several ongoing randomized trials. 7 Given the small effects on intermediate phenotypes and clinical outcomes that have been achieved in published randomized controlled trials of treatments for acute ICH, 8,9 future trials are likely to require large sample sizes to detect the effects of treatment.10 Furthermore, the investigation of treatment effects in subgroups (eg, according to time from ICH onset) requires adequate statistical power to perform the appropriate statistical tests (of interaction).11 However, the rarity of ICH, 1 the short durations of most grant funding schemes, and the regulatory challenges of conducting international multicenter trials limit investigators' abilities to attain required sample sizes.Investigations of the eligibility of patients with ICH for individual randomized trials [12][13][14][15] found that 3.7% to 7.7% of patients were eligible for the Surgical Trial in Lobar ICH (STICH) II trial, 12,14 20% of patients were eligible for a trial of recombinant activated factor VII, 15 and between 4% and 20% might be eligible for hypothetical trials of a treatment for warfarin-related ICH.13 However, the proportions of patients who are eligible for a broad range of recent or ongoing trials and the major determinants of their eligibility are unknown. Therefore, we systematically sought trials from registries and assessed eligibility and its determinants in a contemporaneous, prospective, community-based ICH inception cohort study.Background and Purpose-Acute treatments specifically for intracerebral hemorrhage (ICH) are being sought in randomized controlled trials. The treatment effect sizes in ongoing and future trials are likely to be small, necessitating large sample sizes. Methods-We searched online trial registries for randomized controlled trials investigating an acute treatment for ICH. For the trials whose eligibility criteria could be assessed in a prospective, community-based ICH cohort study (2010)(2011), we quantified the proportions of patients who were eligible and investigated influences on these proportions. Results-We applied the eligibility criteria of 17 trials to 166 adults with ICH, of whom between 0.6% (95% confidence interval, 0. Methods Identification of Trials of Acute Treatment for ICHIn February 2012 we searched for trials investigating treatments for ICH in the trial registries of the Internet Stroke Center (www.internetstrokecenter.org; using the terms hemorrhage, haemorrh...

show abstract

“…In a study using a historical control group, early administration (day 2 after ICH) of subcutaneous lowdose heparin was associated with a decrease in pulmonary emboli without an increase in re-bleeding rates [123]. A recent retrospective study showed that the early use of subcutaneous low molecular weight heparin (LMWH) or unfractionated heparin does not lead to hematoma expansion in the acute (2-4 days) and subacute phase (≤7 days) in both patients with ICH and patients with ICH and associated IVH [124].…”

Section: Deep Vein Thrombosismentioning

confidence: 99%