title: Risk of Ventriculostomy-Associated Hemorrhage in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Anticoagulant Thromboprophylaxis.
abstract: Patients with subarachnoid hemorrhage (SAH) frequently need a ventriculostomy for treatment of hydrocephalus. In some ICU practices, a ventriculostomy is considered a relative contraindication for subcutaneous heparin. We studied the risk of ventriculostomy-associated hemorrhage and deep venous thrombosis (DVT) in patients with anticoagulant prophylaxis.
  
  
  
  This is a retrospective study of 241 consecutive patients with SAH and ventriculostomies treated at Mayo Clinic, Rochester from 2001 to 2014. DVT and pulmonary emboli (PE) prevention included subcutaneous or intravenous heparin, enoxaparin, dalteparin, and warfarin. The incidence of PE and DVT were noted within 30 days of hospital admission. Hemorrhages were classified as minor or major based on size and mass effect.
  
  
  
  Fifty-three (22 %) of the 241 patients were on prophylactic doses of anticoagulation while in the intensive care unit. Three of 53 patients on prophylactic anticoagulation had minor hemorrhages and none had major hemorrhages. Four (7.5 %) of 53 patients who received prophylactic anticoagulation versus 34 (18 %) of 188 patients who did not receive prophylactic anticoagulation developed DVT (p = 0.09). One of 10 patients on therapeutic anticoagulation had a major and fatal hemorrhage.
  
  
  
  In our cohort, the risk of VTE was reduced by more than half in patients receiving chemoprophylaxis. Ventriculostomy-associated hemorrhages were rare and minor. Anticoagulant thromboprophylaxis is mostly safe and required in aneurysmal SAH.
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA. joe.zachariah@gmail.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zachariah
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kendall A
authors.initials: KA
authors.lastname: Snyder
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Graffeo
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Deependra R
authors.initials: DR
authors.lastname: Khanal
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D020246:Venous Thrombosis / Q000517:prevention & control*; D014696:Ventriculostomy / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants
keywords: Deep venous thrombosis; External ventricular drain; Heparin prophylaxis; Intracranial hemorrhage; Pulmonary embolus; Subarachnoid hemorrhage; Venous thromboembolus; Ventriculostomy