Ultra-Early Venous Thromboembolism (VTE) Prophylaxis in Spontaneous Intracerebral Hemorrhage (sICH)

Kananeh, Mohammed; Fonseca-Paricio, Mario; Liang, John; Sullivan, Lindsay T.; Sharma, Kumud; Shah, Syed Omar; Vibbert, Matthew

doi:10.1016/j.jstrokecerebrovasdis.2020.105476

Cited by 9 publications

(6 citation statements)

References 33 publications

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“…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.…”

Section: Safety Of Pharmacological Prophylaxissupporting

confidence: 86%

Venous Thromboembolism Prophylaxis After Spontaneous Intracerebral Hemorrhage

Dong,

Li,

Ma, MD

2023

The Neurologist

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Background: Patients with spontaneous intracerebral hemorrhage (sICH) are at high risk for venous thromboembolism (VTE). The administration of mechanical and pharmacological VTE prophylaxis after sICH is important but challenging. The safety and efficacy of the optimal anticoagulant dose, timing, and type of VTE chemoprophylaxis in cases of sICH are still unclear, and clinicians are concerned that it may lead to cerebral hematoma expansion, which is associated with poor prognosis. Through this literature review, we aim to summarize the latest guidelines, recommendations, and clinical research progress to support evidence-based treatment strategies. Review Summary: It has been proven that intermittent pneumatic compression can effectively reduce the risk of VTE and should be used at the time of hospital admission, whereas gradient compression stockings or lack of prophylaxis in sICH cases are not recommended by current guidelines. Studies regarding pharmacological VTE prophylaxis in patients with ICH were reviewed and summarized. Prophylactic anticoagulation for VTE in patients with ICH seems to be safe and was not associated with cerebral hematoma expansion. Meanwhile, the prophylactic efficacy of anticoagulation for pulmonary embolism seems to be more obvious than that of deep vein thrombosis in patients with ICH. Conclusions: Clinicians should pay attention to the prevention and management of VTE after sICH. Intermittent pneumatic compression should be applied to patients with sICH on the day of hospital admission. After documentation of bleeding cessation, early initiation of pharmacological VTE prophylaxis (24 h to 48 h from sICH onset) seems to be safe and effective in pulmonary embolism prophylaxis.

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Section: Safety Of Pharmacological Prophylaxissupporting

confidence: 86%

Venous Thromboembolism Prophylaxis After Spontaneous Intracerebral Hemorrhage

Dong,

Li,

Ma, MD

2023

The Neurologist

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“…Out of these, 23 studies were excluded due to various reasons such as being written in a language other than English, not being original research articles, lacking comparison between heparin and control groups, absence of efficacy or safety outcome data, and unavailability of extractable data. Following the inclusion and exclusion criteria, 12 studies were eventually included to underpin this meta-analysis, 10 , 11 , 17 – 26 including 7 RCTs (6 for heparin versus control, 1 for early heparin versus late heparin) and 5 cohort studies (3 for heparin versus control, 2 for early heparin versus late heparin). The PRISMA flow chart of this meta-analysis is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Effect of heparin for the prevention of venous thromboembolism in patients with spontaneous intracranial cerebral hemorrhage: a meta-analysis

Zhou,

Wang,

Xue

et al. 2024

Therapeutic Advances in Drug Safety

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Background: Venous thromboembolism (VTE) has a serious impact on the prognosis of patients with spontaneous intracranial hemorrhage (sICH). However, the use of prophylactic heparin remains controversial. Objectives: This study investigated the safety and timing of prophylactic heparin for VTE in patients with sICH. Design: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Methods: Two authors systematically searched Web of Science, Cochrane Library, Embase, and PubMed to find all published research before June 2023. The incidence of deep venous thrombosis (DVT) and mortality were set as primary endpoints. Results: This meta-analysis included seven randomized controlled trials (RCTs) and five observational studies involving a total of 4419 sICH patients in the heparin ( n = 2808) and control ( n = 1183) groups. Among these patients, 205 received early heparin administration, while 223 received late heparin administration. The results suggested that, compared to the control group, patients in the heparin group had a lower incidence of VTE [odds ratio (OR), 0.47; 95% CI, 0.31–0.71; p < 0.001], DVT (OR, 0.53; 95% CI, 0.33–0.85; p = 0.009), pulmonary embolism (OR, 0.31 95% CI, 0.15–0.65; p = 0.002), and mortality (OR, 0.70; 95% CI, 0.54–0.90; p = 0.006), but there were no statistical differences in hematoma enlargement, extracranial hematoma, and major disability ( p > 0.05). There was no statistically significant difference in DVT, mortality, hematoma enlargement, and extracranial hemorrhage between the early heparin group (<24–48 h) and the late heparin group ( p > 0.05). Conclusion: In patients with sICH, prophylactic use of heparin may be beneficial because it reduces the incidence of VTE and mortality without increasing the risk of additional bleeding. In addition, early prophylactic use of heparin appears to be safe. However, large-scale RCTs are lacking to support this evidence.

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“…A recent retrospective study reported that patients who received ultra-early prophylactic anticoagulation (initiated ≤24 hours of radiographic and clinical stability) had a similar rate of hematoma enlargement ≥3 mL to those who received prophylactic anticoagulation at the standard timing (>24 hours). 23 The potential of the ultra-early approach to further reduce thromboembolic complications needs to be verified in future studies. It is also noteworthy that a substantial proportion of ICH patients with major disability at 90 days was observed in both groups (53.7 vs. 44.7%).…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Thromboprophylaxis with Heparins Following Intracerebral Hemorrhage

et al. 2022

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Background The efficacy and safety of pharmacological thromboprophylaxis in patients with intracerebral hemorrhage (ICH) remains unclear. Methods A literature search was performed to collect studies comparing the effect of thromboprophylaxis in patients with ICH. The primary endpoints were deep vein thrombosis (DVT), pulmonary embolism (PE), and hematoma expansion or rebleeding. A meta-analytic approach was employed to estimate the relative risk (RR) by fitting fixed-effects (FE) and random-effects (RE) models. Results A total of 28 studies representing 3,697 hospitalized patients with ICH were included. Thromboprophylaxis was initiated within 4 days following hospital presentation and continued for 10 to 14 days in most of studies. Compared with control, thromboprophylaxis was associated with a reduced risk of DVT (47/1,399 [3.4%] vs. 202/1,377 [14.7%]; FE: RR, 0.24; 95% CI, 0.18–0.32; RE: RR, 0.27; 95% CI, 0.19–0.39) as well as PE (9/953 [0.9%] vs. 37/864 [4.3%]; FE: RR, 0.33; 95% CI, 0.19–0.57; RE: RR, 0.37; 95% CI, 0.21–0.66). Thromboprophylaxis was not associated with increased risk of hematoma expansion or rebleeding (32/1,319 [2.4%] vs. 37/1,301 [2.8%]; FE: RR, 0.75; 95% CI, 0.48–1.18; RE: RR, 0.80; 95% CI, 0.49–1.30) or mortality (117/925 [12.6%] vs. 139/904 [15.4%]; FE: RR, 0.82; 95% CI, 0.65–1.03; RE: RR, 0.83; 95% CI, 0.66–1.04). Conclusion Thromboprophylaxis was effective in preventing DVT and PE without increasing the risk of hematoma expansion or bleeding among ICH patients. Future studies should explore the long-term effects of thromboprophylaxis in this population, particularly on the functional outcomes.

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Ultra-Early Venous Thromboembolism (VTE) Prophylaxis in Spontaneous Intracerebral Hemorrhage (sICH)

Cited by 9 publications

References 33 publications

Venous Thromboembolism Prophylaxis After Spontaneous Intracerebral Hemorrhage

Venous Thromboembolism Prophylaxis After Spontaneous Intracerebral Hemorrhage

Effect of heparin for the prevention of venous thromboembolism in patients with spontaneous intracranial cerebral hemorrhage: a meta-analysis

Systematic Review and Meta-Analysis of Thromboprophylaxis with Heparins Following Intracerebral Hemorrhage

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