title: Is prophylactic anticoagulation for deep venous thrombosis common practice after intracerebral hemorrhage?
abstract: OBJECTIVE
  Prophylactic anticoagulation for deep venous thrombosis prevention after intracerebral hemorrhage (ICH) is safe. Current guidelines recommend prophylactic anticoagulation after cessation of hematoma growth. We aimed to evaluate nationwide trends in deep venous thrombosis prophylaxis after ICH.
  
  
  METHODS
  In an analysis of the Premier database, we identified adult patients with ICH (International Classification of Diseases Ninth edition code 431) from 2006 to 2010 who survived to day 2 of hospitalization. We excluded those with trauma or who underwent craniotomy or angiography. We abstracted type of anticoagulant used and date of first administration. We used univariate statistics and multivariable logistic regression to assess factors associated with prophylactic anticoagulation after ICH.
  
  
  RESULTS
  Among 32 690 (mean age, 69.7 years; 50.1% men) patients with spontaneous ICH, 5395 (16.5%) patients received any prophylactic anticoagulation during the hospital stay. Among these patients, 2416 (44.8%) received prophylactic anticoagulation by day 2. The most commonly used agents were heparin (71.1%), enoxaparin (27.5%), and dalteparin (1.4%). The proportion of patients receiving prophylactic anticoagulation increased slightly during the study period from 14.3% to 18.0% (P<0.01 for trend). Use of prophylactic anticoagulation varied by geographic region (P<0.001) in the United States: Northeast (23.2%), South (19.0%), Midwest (10.8%), and West (9.8%). In multivariable analysis, geographic region remained an independent predictor of prophylactic anticoagulation.
  
  
  CONCLUSIONS
  Less than 20% of patients with ICH receive anticoagulation for deep venous thrombosis in the United States. When used, the time to initiation is <2 days in less than half of the patients. Further study should focus on understanding variations in practice and emphasize guideline-driven care.
authors.affiliation: From the Department of Neurology, Northwestern University, Chicago, IL (S.P.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (P.H., J.K.); and Department of Neurology, University of Cincinnati, OH (O.A., P.K., S.F., D.O.K.). shyam.prabhakaran@northwestern.edu.
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.affiliation: From the Department of Neurology, Northwestern University, Chicago, IL (S.P.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (P.H., J.K.); and Department of Neurology, University of Cincinnati, OH (O.A., P.K., S.F., D.O.K.).
authors.forename: Patricia
authors.initials: P
authors.lastname: Herbers
authors.affiliation: From the Department of Neurology, Northwestern University, Chicago, IL (S.P.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (P.H., J.K.); and Department of Neurology, University of Cincinnati, OH (O.A., P.K., S.F., D.O.K.).
authors.forename: Jane
authors.initials: J
authors.lastname: Khoury
authors.affiliation: From the Department of Neurology, Northwestern University, Chicago, IL (S.P.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (P.H., J.K.); and Department of Neurology, University of Cincinnati, OH (O.A., P.K., S.F., D.O.K.).
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.affiliation: From the Department of Neurology, Northwestern University, Chicago, IL (S.P.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (P.H., J.K.); and Department of Neurology, University of Cincinnati, OH (O.A., P.K., S.F., D.O.K.).
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.affiliation: From the Department of Neurology, Northwestern University, Chicago, IL (S.P.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (P.H., J.K.); and Department of Neurology, University of Cincinnati, OH (O.A., P.K., S.F., D.O.K.).
authors.forename: Simona
authors.initials: S
authors.lastname: Ferioli
authors.affiliation: From the Department of Neurology, Northwestern University, Chicago, IL (S.P.); Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (P.H., J.K.); and Department of Neurology, University of Cincinnati, OH (O.A., P.K., S.F., D.O.K.).
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Kleindorfer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: anticoagulants; pulmonary embolism; thromboembolism