Effect of heparin on secondary brain injury in patients with subarachnoid hemorrhage: an additional 'H' therapy in vasospasm treatment.
OBJECTIVE
Secondary brain injury leads to high morbidity and mortality rates in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, evidence-based treatment strategies are sparse. Since heparin has various effects on neuroinflammation, microthromboembolism and vasomotor function, our objective was to determine whether heparin can be used as a multitarget prophylactic agent to ameliorate morbidity in SAH.


METHODS
Between June 1999 and December 2014, 718 patients received endovascular treatment after rupture of an intracranial aneurysm at our institution; 197 of them were treated with continuous unfractionated heparin in therapeutic dosages after the endovascular procedure. We performed a matched pair analysis to evaluate the effect of heparin on cerebral vasospasm (CVS), cerebral infarction (CI), and outcome.


RESULTS
The rate of severe CVS was significantly reduced in the heparin group compared with the control group (14.2% vs 25.4%; p=0.005). CI and multiple ischemic lesions were less often present in patients with heparin treatment. These effects were enhanced if patients were treated with heparin for >48 hours, but the difference was not significant. Favorable outcome at 6-month follow-up was achieved in 69% in the heparin group and in 65% in the control group.


CONCLUSIONS
Patients receiving unfractionated continuous heparin after endovascular aneurysm occlusion have a significant reduction in the rate of severe CVS, have CI less often, and tend to have a favorable outcome more often. Our findings support the potential beneficial effects of heparin as a multitarget therapy in patients with SAH, resulting in an additional 'H' therapy in vasospasm treatment.
Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany.
Markus
M
Bruder
Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany.
Sae-Yeon
SY
Won
Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany.
Sepide
S
Kashefiolasl
Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany.
Marlies
M
Wagner
Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany.
Nina
N
Brawanski
Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany.
Nazife
N
Dinc
Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany.
Volker
V
Seifert
Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany.
Juergen
J
Konczalla
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001930:Brain Injuries / Q000175:diagnosis / Q000188:drug therapy*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000188:drug therapy*
D000925:Anticoagulants; D006493:Heparin
Aneurysm; Coil; Drug; Hemorrhage; Subarachnoid