title: Prophylactic heparin in acute intracerebral hemorrhage: a propensity score-matched analysis of the INTERACT2 study.
abstract: Indication and timing of pharmacological venous thromboembolism prophylaxis in intracerebral hemorrhage patients is controversial.
  
  
  
  To determine whether use of subcutaneous heparin during the first 7 days after spontaneous intracerebral hemorrhage increases risks of death and disability.
  
  
  
  Data are from the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) study. Patients with acute intracerebral hemorrhage (<6 hours) and elevated systolic blood pressure were included; patients received subcutaneous heparin following local best practice standards of care. Multivariable logistic regression and propensity score matched analysis were used to determine associations of heparin use on death and disability (modified Rankin scale) at 90 days.
  
  
  
  In 2525 patients with available data, there were 465 (22.5%) who received subcutaneous heparin. They had higher death or major disability at 90 days in crude (odds ratio 2.29, 95% confidence interval 1.85-2.84; p < 0.001), adjusted (odds ratio 1.62, 95% confidence interval 1.26-2.09; p < 0.001) and propensity score matched (odds ratio 2.06, 95% confidence interval 1.53-2.77; p < 0.001) analyses. In propensity score matched analysis, heparin-treated patients had significant lower mortality (odds ratio 0.55, 95% CI 0.35-0.87; p = 0.01) but greater major disability (odds ratio 1.68, 95% confidence interval 1.25-2.28; p < 0.001) at 90 days. However, no mortality difference was found in analysis restricted to 48-hour survivors.
  
  
  
  Use of subcutaneous heparin is associated with poor outcome in acute intracerebral hemorrhage, driven by increased residual disability. Despite the limitations of this study, and no clear relation of heparin with bleeding risk, we recommend careful consideration of the need for venous thromboembolism prophylaxis with heparin in intracerebral hemorrhage patients.
  
  
  
  http://www.clinicaltrials.gov NCT00716079.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
authors.forename: Paula
authors.initials: P
authors.lastname: Muñoz-Venturelli
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Xia
authors.initials: X
authors.lastname: Wang
authors.affiliation: Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.affiliation: Department of Neuroscience, CRCHUM, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.affiliation: Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK.
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Lindley
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia canderson@georgeinstitute.org.au.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D004185:Disability Evaluation; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057216:Propensity Score; D016037:Single-Blind Method; D065566:Subcutaneous Absorption; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin
keywords: Cerebral hemorrhage; clinical trial; heparin; intracranial hemorrhage; outcome; prophylaxis; venous thromboembolism