Risk of Ventriculostomy-Associated Hemorrhage in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Anticoagulant Thromboprophylaxis

Joseph Zachariah, Kendall A. Snyder, Christopher S. Graffeo, Deependra R. Khanal, Giuseppe Lanzino, Eelco F M Wijdicks, Alejandro Rabinstein

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)224-229
Number of pages6
JournalNeurocritical Care
Volume25
Issue number2
DOIs
StatePublished - Oct 1 2016

Fingerprint

Ventriculostomy
Subarachnoid Hemorrhage
Anticoagulants
Hemorrhage
Venous Thrombosis
Embolism
Heparin
Dalteparin
Enoxaparin
Lung
Chemoprevention
Warfarin
Hydrocephalus
Intensive Care Units
Retrospective Studies

Keywords

  • Deep venous thrombosis
  • External ventricular drain
  • Heparin prophylaxis
  • Intracranial hemorrhage
  • Pulmonary embolus
  • Subarachnoid hemorrhage
  • Venous thromboembolus
  • Ventriculostomy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology

Cite this

Risk of Ventriculostomy-Associated Hemorrhage in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Anticoagulant Thromboprophylaxis. / Zachariah, Joseph; Snyder, Kendall A.; Graffeo, Christopher S.; Khanal, Deependra R.; Lanzino, Giuseppe; Wijdicks, Eelco F M; Rabinstein, Alejandro.

In: Neurocritical Care, Vol. 25, No. 2, 01.10.2016, p. 224-229.

Research output: Contribution to journalArticle

Zachariah, Joseph ; Snyder, Kendall A. ; Graffeo, Christopher S. ; Khanal, Deependra R. ; Lanzino, Giuseppe ; Wijdicks, Eelco F M ; Rabinstein, Alejandro. / Risk of Ventriculostomy-Associated Hemorrhage in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Anticoagulant Thromboprophylaxis. In: Neurocritical Care. 2016 ; Vol. 25, No. 2. pp. 224-229.
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abstract = "Background: 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. Methods: 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{\^A} days of hospital admission. Hemorrhages were classified as minor or major based on size and mass effect. Results: Fifty-three (22{\^A} {\%}) 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{\^A} {\%}) of 53 patients who received prophylactic anticoagulation versus 34 (18{\^A} {\%}) of 188 patients who did not receive prophylactic anticoagulation developed DVT (p{\^A} ={\^A} 0.09). One of 10 patients on therapeutic anticoagulation had a major and fatal hemorrhage. Conclusion: 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.",
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T1 - Risk of Ventriculostomy-Associated Hemorrhage in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Anticoagulant Thromboprophylaxis

AU - Zachariah, Joseph

AU - Snyder, Kendall A.

AU - Graffeo, Christopher S.

AU - Khanal, Deependra R.

AU - Lanzino, Giuseppe

AU - Wijdicks, Eelco F M

AU - Rabinstein, Alejandro

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

AB - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

KW - Deep venous thrombosis

KW - External ventricular drain

KW - Heparin prophylaxis

KW - Intracranial hemorrhage

KW - Pulmonary embolus

KW - Subarachnoid hemorrhage

KW - Venous thromboembolus

KW - Ventriculostomy

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U2 - 10.1007/s12028-016-0262-x

DO - 10.1007/s12028-016-0262-x

M3 - Article

C2 - 26927278

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SP - 224

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JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

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