Maximilian I Sprügel 1 , Jochen A Sembill 1 , Joji B Kuramatsu 1 , Stefan T Gerner 1 , Manuel Hagen 1 , Sebastian S Roeder 1 , Matthias Endres 2 , Karl Georg Haeusler 2 , Jan Sobesky 2 , Johannes Schurig 2 , Sarah Zweynert 2 , Miriam Bauer 2 , Peter Vajkoczy 3 , Peter Arthur Ringleb 4 , Jan Christoph Purrucker 4 , Timolaos Rizos 4 , Jens Volkmann 5 , Wolfgang Muellges 5 , Peter Kraft 5 , Anna-Lena Schubert 5 , Frank Erbguth 6 , Martin Nueckel 6 , Peter D Schellinger 7 , Jörg Glahn 7 , Ulrich J Knappe 8 , Gereon Rudolf Fink 9 , Christian Dohmen 9 , Henning Stetefeld 9 , Anna Lena Fisse 10 , Jens Minnerup 10 , Georg Hagemann 11 , Florian Rakers 11 , Heinz Reichmann 12 , Hauke Schneider 12 , Sigrid Wöpking 12 , Albert C Ludolph 13 , Sebastian Stösser 13 , Hermann Neugebauer 13 , Joachim Röther 14 , Peter Michels 14 , Michael Schwarz 15 , Gernot Reimann 15 , Hansjörg Bäzner 16 , Henning Schwert 16 , Joseph Classen 17 , Dominik Michalski 17 , Armin Grau 18 , Frederick Palm 18 , Christian Urbanek 18 , Johannes C Wöhrle 19 , Fahid Alshammari 19 , Markus Horn 20 , Dirk Bahner 20 , Otto W Witte 21 , Albrecht Guenther 21 , Gerhard F Hamann 22 , Hannes Lücking 23 , Arnd Dörfler 23 , Stefan Schwab 1 , Hagen B Huttner 24 Show Affiliations »
Abstract
OBJECTIVE: To determine the occurrence of intracranial haemorrhagic complications (IHC) on heparin prophylaxis (low-dose subcutaneous heparin, LDSH) in primary spontaneous intracerebral haemorrhage (ICH) (not oral anticoagulation-associated ICH, non-OAC-ICH), vitamin K antagonist (VKA)-associated ICH and non-vitamin K antagonist oral anticoagulant (NOAC)-associated ICH. METHODS: Retrospective cohort study (RETRACE) of 22 participating centres and prospective single-centre study with 1702 patients with VKA-associated or NOAC-associated ICH and 1022 patients with non-OAC-ICH with heparin prophylaxis between 2006 and 2015. Outcomes were defined as rates of IHC during hospital stay among patients with non-OAC-ICH, VKA-ICH and NOAC-ICH, mortality and functional outcome at 3 months between patients with ICH with and without IHC. RESULTS: IHC occurred in 1.7% (42/2416) of patients with ICH. There were no differences in crude incidence rates among patients with VKA-ICH, NOAC-ICH and non-OAC-ICH (log-rank p=0.645; VKA-ICH: 27/1406 (1.9%), NOAC-ICH 1/130 (0.8%), non-OAC-ICH 14/880 (1.6%); p=0.577). Detailed analysis according to treatment exposure (days with and without LDSH) revealed no differences in incidence rates of IHC per 1000 patient-days (LDSH: 1.43 (1.04-1.93) vs non-LDSH: 1.32 (0.33-3.58), conditional maximum likelihood incidence rate ratio: 1.09 (0.38-4.43); p=0.953). Secondary outcomes showed differences in functional outcome (modified Rankin Scale=4-6: IHC: 29/37 (78.4%) vs non-IHC: 1213/2048 (59.2%); p=0.019) and mortality (IHC: 14/37 (37.8%) vs non-IHC: 485/2048 (23.7%); p=0.045) in disfavour of patients with IHC. Small ICH volume (OR: volume <4.4 mL: 0.18 (0.04-0.78); p=0.022) and low National Institutes of Health Stroke Scale (NIHSS) score on admission (OR: NIHSS <4: 0.29 (0.11-0.78); p=0.014) were significantly associated with fewer IHC. CONCLUSIONS: Heparin administration for venous thromboembolism (VTE) prophylaxis in patients with ICH appears to be safe regarding IHC among non-OAC-ICH, VKA-ICH and NOAC-ICH in this observational cohort analysis. Randomised controlled trials are needed to verify the safety and efficacy of heparin compared with other methods for VTE prevention. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
OBJECTIVE: To determine the occurrence of intracranial haemorrhagic complications (IHC) on heparin prophylaxis (low-dose subcutaneous heparin , LDSH) in primary spontaneous intracerebral haemorrhage (ICH ) (not oral anticoagulation-associated ICH , non-OAC -ICH ), vitamin K antagonist (VKA)-associated ICH and non-vitamin K antagonist oral anticoagulant (NOAC )-associated ICH . METHODS: Retrospective cohort study (RETRACE) of 22 participating centres and prospective single-centre study with 1702 patients with VKA-associated or NOAC -associated ICH and 1022 patients with non-OAC -ICH with heparin prophylaxis between 2006 and 2015. Outcomes were defined as rates of IHC during hospital stay among patients with non-OAC -ICH , VKA-ICH and NOAC -ICH , mortality and functional outcome at 3 months between patients with ICH with and without IHC. RESULTS: IHC occurred in 1.7% (42/2416) of patients with ICH . There were no differences in crude incidence rates among patients with VKA-ICH , NOAC -ICH and non-OAC -ICH (log-rank p=0.645; VKA-ICH : 27/1406 (1.9%), NOAC-ICH 1 /130 (0.8%), non-OAC -ICH 14/880 (1.6%); p=0.577). Detailed analysis according to treatment exposure (days with and without LDSH) revealed no differences in incidence rates of IHC per 1000 patient -days (LDSH: 1.43 (1.04-1.93) vs non-LDSH: 1.32 (0.33-3.58), conditional maximum likelihood incidence rate ratio: 1.09 (0.38-4.43); p=0.953). Secondary outcomes showed differences in functional outcome (modified Rankin Scale=4-6: IHC: 29/37 (78.4%) vs non-IHC: 1213/2048 (59.2%); p=0.019) and mortality (IHC: 14/37 (37.8%) vs non-IHC: 485/2048 (23.7%); p=0.045) in disfavour of patients with IHC. Small ICH volume (OR: volume <4.4 mL: 0.18 (0.04-0.78); p=0.022) and low National Institutes of Health Stroke Scale (NIHSS) score on admission (OR: NIHSS <4: 0.29 (0.11-0.78); p=0.014) were significantly associated with fewer IHC. CONCLUSIONS: Heparin administration for venous thromboembolism (VTE ) prophylaxis in patients with ICH appears to be safe regarding IHC among non-OAC -ICH , VKA-ICH and NOAC -ICH in this observational cohort analysis. Randomised controlled trials are needed to verify the safety and efficacy of heparin compared with other methods for VTE prevention. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Entities: Chemical
Disease
Gene
Species
Keywords:
cerebrovascular disease; critical care; intracerebral heamorrhage; stroke
Year: 2019
PMID： 30992334 DOI： 10.1136/jnnp-2018-319786
Source DB: PubMed Journal: J Neurol Neurosurg Psychiatry ISSN： 0022-3050 Impact factor: 10.154