Early Versus Delayed Initiation of Pharmacological Venous Thromboembolism Prophylaxis After an Intracranial Hemorrhage

Faust, Andrew C.; Finch, Christopher K.; Hurdle, April C.; Elijovich, Lucas

doi:10.1097/nrl.0000000000000141

Cited by 11 publications

(11 citation statements)

References 14 publications

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“…Although there is considerable apprehension about starting VTE prophylaxis after ICH, multiple trials have demonstrated that there is no increased risk of hematoma expansion when VTE prophylaxis is initiated within 48 hours [61][62][63]. Current guidelines recommend initiating mechanical VTE prophylaxis at the time of hospital admission and chemical VTE prophylaxis with unfractionated heparin or low-molecular-weight heparin within 1-4 days of admission in patients with stable hematomas and no evidence of ongoing coagulopathy, but preferentially within 48 hours (Table 8) [5,54]. Appropriately dosed for weight and organ function, VTE prophylaxis is recommended in all older adult patients unless a contraindication exists [64].…”

Section: Venous Thromboembolism (Vte) Prophylaxismentioning

confidence: 99%

Pharmacological Management of Spontaneous Intracerebral Hemorrhage in Older Adults

Sandler¹,

Almohaish²,

Brophy³

2021

OBM Geriatrics

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Pharmacological management of intracerebral hemorrhage in adult patients over 65 years of age requires special considerations due to differing clinical presentations, underlying organ dysfunction, and more complex medical histories and medication profiles. A literature review of articles focusing on the age-specific pharmacological management of intracerebral hemorrhage was conducted. Treatment approaches and clinical outcomes specific to older adults were evaluated and therapeutic considerations for this population are summarized. Older adults were commonly included in trials regarding reversal of anticoagulants and antiplatelet agents and these results are generalizable to older adults. Underlying organ dysfunction should frequently be considered throughout the treatment of intracerebral hemorrhage in older adults. Older adults with intracerebral hemorrhage should be managed similarly to younger adult patients; however, consideration of age-related comorbidities and physiological differences is critically important for optimizing patient care.

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Section: Venous Thromboembolism (Vte) Prophylaxismentioning

confidence: 99%

Pharmacological Management of Spontaneous Intracerebral Hemorrhage in Older Adults

Sandler¹,

Almohaish²,

Brophy³

2021

OBM Geriatrics

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“…Venous thromboembolism is a common complication for patients suffering from a spontaneous intracerebral hemorrhage (ICH) [1,2]. The two primary methods of VTE prevention in use today are mechanical compression and pharmacological thromboprophylaxis.…”

Section: Introductionmentioning

confidence: 99%

“…While commonly used to prevent VTE in a variety of medical scenarios [11], the use of pharmacological thromboprophylaxis in ICH is an area of ongoing debate. The primary concern is that these medications may exacerbate intracranial bleeding but this has not been demonstrated in observational studies [1,12].…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism prevention in intracerebral hemorrhage: A systematic review and network meta-analysis

et al. 2020

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Introduction To summarize and compare the effectiveness of pharmacological thromboprophylaxis to pneumatic compression devices (PCD) for the prevention of venous thromboembolism in patients with acute intracerebral hemorrhage. Methods MEDLINE, PUBMED, EMBASE, and CENTRAL were systematically searched to identify randomized and non-randomized studies that compared each intervention directly to each other or against a common control (hydration, anti-platelet agents, stockings) in adults with acute spontaneous intracerebral hemorrhage. Two investigators independently screened the studies, extracted data, and appraised risk of bias. Studies with a high risk of bias were excluded from our final analysis. The primary outcome was the occurrence of venous thromboembolism (proximal deep vein thrombosis or pulmonary embolism) in the first 30 days. Results 8,739 articles were screened; four articles, all randomized control trials, met eligibility criteria. Bayesian network meta-analysis was performed to calculate risk estimates using both fixed and random effects analyses. 607 patients were included in the network analysis. PCD were associated with a significant decrease in venous thromboembolism compared to control (OR: 0.43, 95% Credible Limits [CrI]: 0.23-0.80). We did not find evidence of statistically significant differences between pharmacological thromboprophylaxis and control (OR: 0.93, 95% CrI: 0.19-4.37) or between PCD and pharmacological thromboprophylaxis (OR: 0.47, 95% CrI: 0.09-2.54).

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“… 2 To further complicate matters, patients with intracerebral haemorrhage are at an increased risk of venous thromboembolism (VTE). 3 The rates of symptomatic deep vein thrombosis (DVT) in intracerebral haemorrhage varies from 3% to 7%, and subclinical thrombotic events are reported to be as high as 17%. 4 5 The prophylactic prevention of this disorder is critical in preventing worsened outcomes.…”

Section: Introductionmentioning

confidence: 99%

“… 7 Although trial data are limited, observational data have not shown an increased risk in haematoma expansion with the use of pharmacological antithrombotics. 3 8 Regardless, the concerns of haematoma expansion have contributed to the infrequent use of these agents in clinical practice. 9 …”

Section: Introductionmentioning

confidence: 99%

Comparing pharmacological venous thromboembolism prophylaxis to intermittent pneumatic compression in acute intracerebral haemorrhage: protocol for a systematic review and network meta-analysis

et al. 2018

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IntroductionPatients with an intracerebral haemorrhage are at increased risk of venous thromboembolism. Pharmacotherapy and pneumatic compression devices are capable of preventing venous thromboembolism, however both interventions have limitations. There are no head-to-head comparisons between these two interventions. To address this knowledge gap, we plan to perform a systematic review and network meta-analysis to examine the comparative effectiveness of pharmacological prophylaxis and mechanical compression devices in the context of intracerebral haemorrhage.Methods and analysisMEDLINE, PUBMED, EMBASE, CENTRAL, ClinicalTrials.gov and the Internet Stroke Trials Registry will be searched with assistance from an experienced information specialist. Eligible studies will include those that have enrolled adults presenting with spontaneous intracerebral haemorrhage and compared one or more of the respective interventions against each other and/or a control. Primary outcomes to be assessed are occurrence of new venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) and haematoma expansion, defined as a significant enlargement of baseline haemorrhage or new haemorrhage occurrence. Both randomised and non-randomised comparative studies will be included. Data on participant characteristics, study design, intervention details and outcomes will be extracted. Study quality will be assessed using the Cochrane Risk of Bias Tool and the Robins-I tool. Bayesian network meta-analyses will be performed to compare interventions based on all available direct and indirect evidence. If the transitivity assumption for network meta-analysis cannot be met, we will perform a qualitative assessment.Ethics and disseminationFormal ethics is not required as primary data will not be collected. The findings of this study will be disseminated through conference presentations, and peer-reviewed publications. In an area of clinical practice where equipoise exists, the findings of this study may assist in determining which treatment intervention is most effective in venous thromboembolism prevention.PROSPERO registration numberCRD42018090960.

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Early Versus Delayed Initiation of Pharmacological Venous Thromboembolism Prophylaxis After an Intracranial Hemorrhage

Cited by 11 publications

References 14 publications

Pharmacological Management of Spontaneous Intracerebral Hemorrhage in Older Adults

Pharmacological Management of Spontaneous Intracerebral Hemorrhage in Older Adults

Venous thromboembolism prevention in intracerebral hemorrhage: A systematic review and network meta-analysis

Comparing pharmacological venous thromboembolism prophylaxis to intermittent pneumatic compression in acute intracerebral haemorrhage: protocol for a systematic review and network meta-analysis

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