PMID- 29959066
OWN - NLM
STAT- MEDLINE
DCOM- 20181015
LR  - 20181015
IS  - 1878-8769 (Electronic)
IS  - 1878-8750 (Linking)
VI  - 117
DP  - 2018 Sep
TI  - Low-Dose versus Therapeutic Range Intravenous Unfractionated Heparin Prophylaxis 
      in the Treatment of Patients with Severe Aneurysmal Subarachnoid Hemorrhage After 
      Aneurysm Occlusion.
PG  - e705-e711
LID - S1878-8750(18)31334-2 [pii]
LID - 10.1016/j.wneu.2018.06.118 [doi]
AB  - BACKGROUND: While prophylaxis with intravenous unfractionated heparin (UFH) can 
      effectively prevent venous thromboembolism (VTE) during the neurocritical care of 
      patients with severe aneurysmal subarachnoid hemorrhage (aSAH), the risk for 
      intracranial bleeding complications might increase. Owing to this therapeutic 
      dilemma, the UFH administration regimen in this critical patient population 
      remains highly controversial. METHODS: We performed a retrospective analysis of 
      patients with severe aSAH (Fisher grade 3-4) receiving either low-dose (activated 
      partial thromboplastin time [aPTT] <40 seconds) or therapeutic range (aPTT 50-60 
      seconds) UFH during intensive care unit (ICU) treatment after complete 
      surgical/endovascular aneurysm occlusion. The primary outcome was the rate of 
      bleeding/VTE complications and the investigation of potential risk factors. 
      RESULTS: This study series comprised 410 patients with aneurysmal SAH (aSAH), 
      with a mean age of 54.7 +/- 12.6 years, a male:female ratio of 1:2.2, and 
      aSAH-associated intracerebral hemorrhage (ICH) in 33.2%. After complete aneurysm 
      occlusion, 112 patients (27.3%) received therapeutic dose UFH and 298 patients 
      (72.7%) received low-dose UFH. VTE events occurred in 5.4% of the low-dose UFH 
      cohort and in 6.3% of the therapeutic dose UFH cohort, with no significant 
      differences in the rate and severity of VTE events. However, an increase in 
      initial SAH-associated ICH was significantly (P = 0.007) more frequent in the 
      therapeutic dose cohort (18.8% vs. 3.4%). Heparin-induced thrombocytopenia (HIT) 
      was the sole risk factor for VTE (P < 0.001), and both an aPTT >/=50 seconds under 
      UFH administration (P = 0.007) and the initial presence of SAH-associated ICH 
      (P = 0.035) were significant risk factors for intracranial bleeding 
      complications. CONCLUSIONS: Even in high-risk neurocritical patients with severe 
      SAH and prolonged ICU treatment, low-dose UFH-administration for VTE prophylaxis 
      is equally effective as therapeutic UFH administration and carries a lower risk 
      of bleeding complications.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Kunz, Mathias
AU  - Kunz M
AD  - Department of Neurosurgery, University Hospital, Ludwig Maximilian University, 
      Munich, Germany.
FAU - Siller, Sebastian
AU  - Siller S
AD  - Department of Neurosurgery, University Hospital, Ludwig Maximilian University, 
      Munich, Germany. Electronic address: Sebastian.Siller@med.uni-muenchen.de.
FAU - Nell, Carolina
AU  - Nell C
AD  - Department of Neurosurgery, University Hospital, Ludwig Maximilian University, 
      Munich, Germany.
FAU - Schniepp, Roman
AU  - Schniepp R
AD  - Department of Neurology, University Hospital, Ludwig Maximilian University, 
      Munich, Germany.
FAU - Dorn, Franziska
AU  - Dorn F
AD  - Institute of Neuroradiology, University Hospital, Ludwig Maximilian University, 
      Munich, Germany.
FAU - Huge, Volker
AU  - Huge V
AD  - Institute of Anesthesiology, University Hospital, Ludwig Maximilian University, 
      Munich, Germany.
FAU - Tonn, Joerg-Christian
AU  - Tonn JC
AD  - Department of Neurosurgery, University Hospital, Ludwig Maximilian University, 
      Munich, Germany.
FAU - Pfister, Hans-Walter
AU  - Pfister HW
AD  - Department of Neurology, University Hospital, Ludwig Maximilian University, 
      Munich, Germany.
FAU - Schichor, Christian
AU  - Schichor C
AD  - Department of Neurosurgery, University Hospital, Ludwig Maximilian University, 
      Munich, Germany.
LA  - eng
PT  - Journal Article
DEP - 20180627
PL  - United States
TA  - World Neurosurg
JT  - World neurosurgery
JID - 101528275
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Administration, Intravenous
MH  - Anticoagulants/*administration & dosage
MH  - Comorbidity
MH  - Critical Care
MH  - Female
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Intracranial Aneurysm/*drug therapy/epidemiology/surgery
MH  - Male
MH  - Middle Aged
MH  - Postoperative Care
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Subarachnoid Hemorrhage/*drug therapy/epidemiology/surgery
MH  - Venous Thromboembolism/epidemiology/prevention & control
OTO - NOTNLM
OT  - Aneurysmal subarachnoid hemorrhage
OT  - Anticoagulation
OT  - Low-dose range
OT  - Pulmonary embolism
OT  - Therapeutic range
OT  - Thromboembolism
OT  - Unfractionated heparin
EDAT- 2018/07/01 06:00
MHDA- 2018/10/16 06:00
CRDT- 2018/07/01 06:00
PHST- 2018/04/15 00:00 [received]
PHST- 2018/06/12 00:00 [revised]
PHST- 2018/06/14 00:00 [accepted]
PHST- 2018/07/01 06:00 [pubmed]
PHST- 2018/10/16 06:00 [medline]
PHST- 2018/07/01 06:00 [entrez]
AID - S1878-8750(18)31334-2 [pii]
AID - 10.1016/j.wneu.2018.06.118 [doi]
PST - ppublish
SO  - World Neurosurg. 2018 Sep;117:e705-e711. doi: 10.1016/j.wneu.2018.06.118. Epub 
      2018 Jun 27.