Use of heparin in neurointervention: a review of the literature

Abstract

Background: The use of heparin is routine in endovascular procedures as a strategy in many centers that perform neurointerventional procedures to prevent occlusion of the catheters, but the use of this drug carries risks such as heparininduced thrombocytopenia.Objective: The purpose of this paper is to present a review of the literature.Material and methods: We conducted an extensive search and review of published papers about heparin and neurointerventional procedures.Results: The evidence in the literature is weak in relation to the use of heparin and the reduction of embolic effects associated with their use in endovascular procedures. Conclusion:The evidence on the use of heparin for the prevention of thromboembolic events in endovascular procedures are of low quality. There is insufficient evidence to conclude a potential benefit of heparin is useful in neurointerventional procedures. Prospective studies are needed to determine the effectiveness of heparin and avoid exposing patients to potential risks.

Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms

“…The observed risks of silent and symptomatic events following coiling procedures call for improving current protective therapies. The routine administration of unfractionated intravenous heparin is not sufficient,3 although it has been associated with significantly less DWI load 4. No neuroprotective agents are approved in this setting, but some have shown promising results 5.…”

“…The high rates of brain embolization during coiling procedures indicate the inadequacy of current antithrombotic protective therapies. Intravenous heparin has limited protective efficacy 3 4. Antiplatelet therapy is currently given only when stent use is planned and not typically used before simple unassisted coiling or coiling with multiple microcatheters or using balloon-assistance (hereafter collectively called coiling-only procedures).…”

Initial experience with aneurysm coiling in Nepal

“…Infusion pumps were used to deliver nimodipine 15ml (0.2mg/ml) in 1000ml of normal saline, and heparin 0.5ml (5000IU/1ml) in 1000 ml of normal saline. 25 Special precautions were taken to prevent air embolism. Access to femoral artery was performed with Seldinger technique with 7 French long femoral sheath with the guide of Teromo guide wire 0.035".…”

Basics of Neurointervention

“…All the catheters and sheaths should also be continuously flushed with heparinized saline (1,000-2,000 U in 1 L) with the help of pressure bags as per the institutional protocol. 5…”