Pharmacological deep vein thrombosis prophylaxis does not lead to hematoma expansion in intracerebral hemorrhage with intraventricular extension.
OBJECTIVE
Patients with intracerebral hemorrhage (ICH) are at high risk for development of deep venous thrombosis. Current guidelines state that low-dose subcutaneous low molecular weight heparin or unfractionated heparin may be considered at 3 to 4 days from onset. However, insufficient data exist on hematoma volume in patients with ICH before and after pharmacological deep venous thrombosis prophylaxis, leaving physicians with uncertainty regarding the safety of this practice.


METHODS
We identified patients from our stroke registry (June 2003 to December 2007) who presented with ICH only or ICH+intraventricular hemorrhage and received either low molecular weight heparin subcutaneously or unfractionated heparin within 7 days of admission and had a repeat CT scan performed within 4 days of starting deep venous thrombosis prophylaxis. We calculated the change in hematoma volume from the admission and posttreatment CTs. Hematoma volume was calculated using the ABC/2 method and intraventricular hemorrhage volumes were calculated using a published method of hand drawn regions of interest.


RESULTS
We identified 73 patients with a mean age of 63 years and median National Institutes of Health Stroke Scale score 11.5. The mean baseline total hematoma volume was 25.8 mL±23.2 mL. There was an absolute change in hematoma volume from pre- and posttreatment CT of -4.3 mL±11.0 mL. Two patients developed hematoma growth. Repeat analysis of patients given pharmacological deep venous thrombosis prophylaxis within 2 or 4 days after ICH found no increase in hematoma size.


CONCLUSIONS
Pharmacological deep venous thrombosis prophylaxis given subcutaneously in patients with ICH and/or intraventricular hemorrhage in the subacute period is generally not associated with hematoma growth.
Department of Neurology, The University of Texas-Houston Medical School, 6431 Fannin Street Suite, Houston, TX 77030, USA.
Tzu-Ching
TC
Wu
Mallik
M
Kasam
Nusrat
N
Harun
Hen
H
Hallevi
Hesna
H
Bektas
Indrani
I
Acosta
Vivek
V
Misra
Andrew D
AD
Barreto
Nicole R
NR
Gonzales
George A
GA
Lopez
James C
JC
Grotta
Sean I
SI
Savitz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006406:Hematoma / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000473:pathology
D006495:Heparin, Low-Molecular-Weight; D006493:Heparin
Stroke. 1997 Dec;28(12):2370-5
9412616
J Neurol Sci. 2008 Sep 15;272(1-2):83-6
18555486
Br Med J. 1976 May 15;1(6019):1178-81
1268614
Surg Neurol. 2008 Jan;69(1):40-5; discussion 45
18054613
Stroke. 2006 Feb;37(2):404-8
16373654
Stroke. 1997 Jan;28(1):1-5
8996478
Stroke. 2007 May;38(5):1655-711
17431204
AJNR Am J Neuroradiol. 2006 Mar;27(3):666-70
16552014
Neurology. 2005 Sep 27;65(6):865-9
16186525
Neurologist. 2009 Nov;15(6):329-31
19901711
J Neurol Neurosurg Psychiatry. 1991 May;54(5):466-7
1865215
Stroke. 2007 Jun;38(6):2001-23
17478736
Stroke. 1996 Oct;27(10):1783-7
8841330
Cerebrovasc Dis. 2009;27(2):146-50
19039218
Am J Cardiol. 2005 Dec 15;96(12):1731-3
16360366
Klin Wochenschr. 1988 Dec 1;66(23):1182-3
3062268