A non-randomized study of safety and efficacy of heparin for DVT prophylaxis in intracerebral haemorrhage.
OBJECTIVE
To evaluate the safety and efficacy of subcutaneous heparin for deep venous thrombosis (DVT) prophylaxis in patients with intracerebral haemorrhage (ICH) during acute phase in comparison to elastic stockings.


METHODS
The diagnosis of ICH was based on imaging (CT or MRI) and DVT was based on Doppler ultrasound.


RESULTS
A total of 458 patients were identified over a period of 5 years (1997-2001). Median age was 59 years (range:12-99 years). Two hundred (44%) patients received heparin (heparin group) in addition to elastic stockings and 258 (56%) patients were only given elastic stockings (stockings group). These two groups were not randomized. Heparin was administered subcutaneously (SQ) in doses of 2500-5000 international units twice daily. Two groups were matched for age (p = 0.5), sex (p = 0.28), presence of diabetes mellitus (p = 0.14), cigarette smoking (p = 0.045) and presence of hydrocephalus or midline shift on CT/MRI (p= 0.87). One patient developed DVT in control group while none developed DVT in heparin group (p = 0.18). One patient had worsening of ICH on repeat CT scan in Heparin group. This worsening was non fatal. Systemic haemorrhagic complications (non fatal) were seen in 7 (14%) patients receiving heparin. Twenty five patients (12%) in heparin group and 52 (20%) in control group died (p = 0.02).


CONCLUSIONS
Subcutaneous heparin in doses of 2500-5000 units twice daily during acute phase in patients with ICH may be safe for DVT prophylaxis. It was not superior to elastic stockings in a non-randomized comparison to prevent DVT.
Wasay
Mohammad
M
Department of Neurology and Medicine, The Aga Khan University, Karachi, Pakistan.
Khan
Saqibuddin
S
Zaki
Khawaja S
KS
Khealani
Bhojo A
BA
Kamal
Ayeesha
A
Azam
Iqbal
I
Khatri
Ismail A
IA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002648:Child; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012189:Retrospective Studies; D053828:Stockings, Compression; D015996:Survival Rate; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D006493:Heparin