Safety of early pharmacological thromboprophylaxis after subarachnoid hemorrhage.
OBJECTIVE
The recent guidelines on management of aneurysmal subarachnoid hemorrhage (aSAH) advise pharmacological thromboprophylaxis (PTP) after aneurysm obliteration. However, no study has addressed the safety of PTP in the aSAH population. Therefore, the aim of this study was to assess the safety of early PTP after aSAH.


METHODS
Retrospective cohort of aSAH patients admitted between January 2012 and June 2013 in a single high-volume aSAH center. Traumatic SAH and perimesencephalic hemorrhage patients were excluded. Patients were grouped according to PTP timing: early PTP group (PTP within 24 hours of aneurysm treatment), and delayed PTP group (PTP started > 24 hours).


RESULTS
A total of 174 SAH patients (mean age 56.3±12.5 years) were admitted during the study period. Thirty-nine patients (22%) did not receive PTP, whereas 135 patients (78%) received PTP after aneurysm treatment or negative angiography. Among the patients who received PTP, 65 (48%) had an external ventricular drain. Twenty-eight patients (21%) received early PTP, and 107 (79%) received delayed PTP. No patient in the early treatment group and three patients in the delayed PTP group developed an intracerebral hemorrhagic complication. Two required neurosurgical intervention and one died. These three patients were on concomitant PTP and dual antiplatelet therapy.


CONCLUSIONS
The initiation of PTP within 24 hours may be safe after the treatment of a ruptured aneurysm or in angiogram-negative SAH patients with diffuse aneurysmal hemorrhage pattern. We suggest caution with concomitant use of PTP and dual antiplatelet agents, because it possibly increases the risk for intracerebral hemorrhage.
1Department of Critical Care Medicine,Trauma & Neurosurgical Intensive Care Unit.
Airton Leonardo de Oliveira
AL
Manoel
2Department of Medical Imaging,Interventional Neuroradiology.
David
D
Turkel-Parrella
1Department of Critical Care Medicine,Trauma & Neurosurgical Intensive Care Unit.
Menno
M
Germans
2Department of Medical Imaging,Interventional Neuroradiology.
Ekaterina
E
Kouzmina
2Department of Medical Imaging,Interventional Neuroradiology.
Priscila da Silva
Pda S
Almendra
2Department of Medical Imaging,Interventional Neuroradiology.
Thomas
T
Marotta
2Department of Medical Imaging,Interventional Neuroradiology.
Julian
J
Spears
1Department of Critical Care Medicine,Trauma & Neurosurgical Intensive Care Unit.
Simon
S
Abrahamson
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; 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; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013921:Thrombocytopenia / Q000139:chemically induced / Q000000981:diagnostic imaging; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D006495:Heparin, Low-Molecular-Weight; D006493:Heparin