PMID- 35231899
OWN - NLM
STAT- MEDLINE
DCOM- 20220406
LR  - 20220406
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 52
IP  - 3
DP  - 2022 Mar
TI  - Heparin in the treatment of aneurysmal subarachnoid hemorrhage: a systematic 
      review and meta-analysis.
PG  - E9
LID - 2021.12.FOCUS21419 [pii]
LID - 10.3171/2021.12.FOCUS21419 [doi]
AB  - OBJECTIVE: Cerebral vasospasm and the resulting infarction remain the most 
      devastating complications of aneurysmal subarachnoid hemorrhage (aSAH). Limited 
      treatment options are available, with nimodipine as the only approved 
      prophylactic medication. In addition to its anticoagulant properties, heparin 
      also has a pleiotropic and anti-inflammatory effect that could be beneficial in 
      vasospasm. In this study, the authors sought to evaluate the efficacy and safety 
      of heparin in the treatment of aSAH. METHODS: The PubMed, EBSCOhost, Europe PMC, 
      and Cochrane Central databases were searched to find studies including patients 
      with aSAH who were treated with intravenous unfractionated heparin (UFH) after an 
      aneurysm-securing procedure. Studies that did not include a comparison with UFH 
      or low-molecular-weight heparin in deep vein thrombosis prophylactic doses were 
      excluded. The primary outcome was cerebral vasospasm, and the secondary outcomes 
      were cerebral infarction, clinical deterioration caused by delayed cerebral 
      ischemia, bleeding complications, and thromboembolism complications. RESULTS: 
      Overall, 5 nonrandomized studies were included; 4 studies evaluated the safety 
      and 3 studies evaluated the efficacy of intravenous heparin. From the analysis of 
      3 studies with a total of 895 patients, administration of intravenous UFH for > 
      48 hours was related to a significantly lower rate of cerebral infarction (OR 
      0.44, 95% CI 0.25-0.79). No significant association was found with other efficacy 
      outcomes. Regarding cognitive outcome, one study found a significant improvement 
      in Montreal Cognitive Assessment scores; however, the functional outcome as 
      indicated by the modified Rankin Scale score was not improved by heparin 
      administration. From the analysis of 4 studies with 1099 patients, no significant 
      increases in bleeding and other complications were found. CONCLUSIONS: 
      Administration of intravenous UFH for more than 48 hours reduced the rate of 
      cerebral infarction with a good safety profile. This result supports the ongoing 
      clinical trial.
FAU - Lukito, Patrick P
AU  - Lukito PP
AD  - 1Faculty of Medicine and.
FAU - Lie, Hendry
AU  - Lie H
AD  - 1Faculty of Medicine and.
FAU - Helsa, Karina
AU  - Helsa K
AD  - 1Faculty of Medicine and.
FAU - July, Julius
AU  - July J
AD  - 2Department of Neurosurgery, Neuroscience Centre Siloam Hospital, Faculty of 
      Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - *Brain Ischemia/complications
MH  - Heparin/therapeutic use
MH  - Humans
MH  - *Subarachnoid Hemorrhage/complications/drug therapy
MH  - *Vasospasm, Intracranial/drug therapy/etiology/prevention & control
OTO - NOTNLM
OT  - aneurysmal subarachnoid hemorrhage
OT  - efficacy
OT  - heparin
OT  - outcome
OT  - safety
OT  - treatment
EDAT- 2022/03/02 06:00
MHDA- 2022/04/07 06:00
CRDT- 2022/03/01 20:19
PHST- 2021/07/23 00:00 [received]
PHST- 2021/12/10 00:00 [accepted]
PHST- 2022/03/01 20:19 [entrez]
PHST- 2022/03/02 06:00 [pubmed]
PHST- 2022/04/07 06:00 [medline]
AID - 2021.12.FOCUS21419 [pii]
AID - 10.3171/2021.12.FOCUS21419 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2022 Mar;52(3):E9. doi: 10.3171/2021.12.FOCUS21419.