Early thrombosis prophylaxis with enoxaparin is not associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage.

Aged Anticoagulants / adverse effects Cerebral Hemorrhage / complications Enoxaparin / adverse effects Female Glasgow Coma Scale Hematoma / etiology Humans Male Middle Aged Risk Factors Thrombolytic Therapy / adverse effects Venous Thrombosis / drug therapy
intracerebral hemorrhage low-molecular-weight heparin venous thrombosis

Journal

European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311

Informations de publication

Date de publication:
02 2019
Historique:
received: 25 06 2018
accepted: 08 10 2018
pubmed: 12 10 2018
medline: 25 6 2019
entrez: 12 10 2018
Statut: ppublish

Résumé

Early pharmacological deep vein thrombosis (DVT) prophylaxis is recommended by guidelines, but rarely started within 48 h. We aimed to analyze the effect of early (within 48 h) versus late (>48 h) DVT prophylaxis on hematoma expansion (HE) and outcome in patients with spontaneous intracerebral hemorrhage (ICH). We analyzed 134 consecutive patients admitted to a tertiary neurointensive care unit with diagnosed spontaneous ICH, without previous anticoagulation, severe coagulopathy, hematoma evacuation, early withdrawal of therapy or ineligibility for DVT prophylaxis according to our institutional protocol. Significant late HE was defined as ≥6 mL increase of hematoma volume between neuroimaging within 48 h and day 3-6. Multivariate analysis was performed to identify risk factors for late HE, poor 3-month outcome (modified Rankin Scale score ≥ 4) and mortality. Patients had a median Glasgow Coma Scale score of 14 [interquartile range (IQR), 10-15], ICH volume of 11 (IQR, 5-24) mL and were 71 (IQR, 61-76) years old. A total of 56% (n = 76) received early DVT prophylaxis, 37% (n = 50) received late DVT prophylaxis and 8 (6%) had unknown bleeding onset. Patients with early DVT prophylaxis had smaller ICH volume [9.5 (IQR, 4-18.5) vs. 17.5 (IQR, 8-29) mL, P = 0.038] and were more often comatose (26% vs. 10%, P = 0.025). Significant late HE [n = 5/134 (3.7%)] was associated with larger initial ICH volume (P = 0.02) and lower thrombocyte count (P = 0.03) but not with early DVT prophylaxis (P = 0.36). Early DVT prophylaxis was not associated with worse outcome. Significant late HE is uncommon and DVT prophylaxis within 48 h of symptom onset may be safe in selected patients with ICH.

Sections du résumé

BACKGROUND AND PURPOSE
Early pharmacological deep vein thrombosis (DVT) prophylaxis is recommended by guidelines, but rarely started within 48 h. We aimed to analyze the effect of early (within 48 h) versus late (>48 h) DVT prophylaxis on hematoma expansion (HE) and outcome in patients with spontaneous intracerebral hemorrhage (ICH).
METHODS
We analyzed 134 consecutive patients admitted to a tertiary neurointensive care unit with diagnosed spontaneous ICH, without previous anticoagulation, severe coagulopathy, hematoma evacuation, early withdrawal of therapy or ineligibility for DVT prophylaxis according to our institutional protocol. Significant late HE was defined as ≥6 mL increase of hematoma volume between neuroimaging within 48 h and day 3-6. Multivariate analysis was performed to identify risk factors for late HE, poor 3-month outcome (modified Rankin Scale score ≥ 4) and mortality.
RESULTS
Patients had a median Glasgow Coma Scale score of 14 [interquartile range (IQR), 10-15], ICH volume of 11 (IQR, 5-24) mL and were 71 (IQR, 61-76) years old. A total of 56% (n = 76) received early DVT prophylaxis, 37% (n = 50) received late DVT prophylaxis and 8 (6%) had unknown bleeding onset. Patients with early DVT prophylaxis had smaller ICH volume [9.5 (IQR, 4-18.5) vs. 17.5 (IQR, 8-29) mL, P = 0.038] and were more often comatose (26% vs. 10%, P = 0.025). Significant late HE [n = 5/134 (3.7%)] was associated with larger initial ICH volume (P = 0.02) and lower thrombocyte count (P = 0.03) but not with early DVT prophylaxis (P = 0.36). Early DVT prophylaxis was not associated with worse outcome.
CONCLUSION
Significant late HE is uncommon and DVT prophylaxis within 48 h of symptom onset may be safe in selected patients with ICH.

Identifiants

DOI: 10.1111/ene.13830 PMID: 30308696
pubmed: 30308696
doi: 10.1111/ene.13830
doi:

Substances chimiques

Anticoagulants 0
Enoxaparin 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

333-341

Subventions

Organisme : Austrian Science Fund FWF
ID : P 29076
Pays : Austria
Organisme : Austrian Science Fund FWF
ID : FWF - P 29076
Pays : Austria

Informations de copyright

© 2018 EAN.

Auteurs

B Ianosi (B)

Institute of Medical Informatics, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall.
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
ORCID: 0000-0003-0705-4901

M Gaasch (M)

Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

V Rass (V)

Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

L Huber (L)

Institute of Medical Informatics, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall.

W Hackl (W)

Institute of Medical Informatics, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall.

M Kofler (M)

Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

A J Schiefecker (AJ)

Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

A Addis (A)

Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.

R Beer (R)

Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

P Rhomberg (P)

Department of Neuroradiology, Medical University of Innsbruck, Innsbruck.

B Pfausler (B)

Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

C Thomé (C)

Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.

E Ammenwerth (E)

Institute of Medical Informatics, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall.

R Helbok (R)

Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Hémorragies intracrâniennes › Hémorragie cérébrale › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › Glucides › Polyosides › Glycosaminoglycanes › Héparine › Héparine bas poids moléculaire › Énoxaparine › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Échelle de coma de Glasgow › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Hématome › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Traitement thrombolytique › Early thrombosis prophylaxis with enoxaparin...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Thrombose › Thrombose veineuse › Early thrombosis prophylaxis with enoxaparin...