Neurosurgery. 2019 Mar 1;84(3):709-716. doi: 10.1093/neuros/nyy189.
Venous thromboembolism (VTE) after intracerebral hemorrhage is well studied, but data on patients with spontaneous intraventricular hemorrhage (IVH) are limited.
To study the factors associated with VTE, association between VTE and clinical outcomes in IVH, and safety of VTE chemoprophylaxis in IVH treated with intraventricular catheters and thrombolysis.
Retrospective cohort study of patients enrolled in the CLEAR III trial, a multicenter, randomized trial comparing external ventricular drainage, with administration of intraventricular alteplase vs placebo, for obstructive IVH. Predictor variable was incident VTE in the first 30 d. Outcome measures were factors associated with VTE, and death/severe disability (modified Rankin Score 4-6) at 6 mo.
Of the 500 patients with IVH, VTE occurred in 59 patients (11.8%) within the first 30 d. VTE chemoprophylaxis was initiated in 412 (82.4%) patients, but before VTE diagnosis in only 401 (80.2%) at median of 4 d (interquartile range, 1-8) from IVH onset, and was not associated with intracranial bleeding or catheter tract hemorrhage. In the multivariate logistic regression analysis, infection within 30 d (odds ratio, 1.80; confidence interval, 1.03-3.17) was significantly associated with higher odds of VTE occurrence. Starting VTE chemoprophylaxis after 72 h was additionally associated with VTE occurrence after the first week.
Infection and delay in timely initiation of VTE chemoprophylaxis were associated with VTE occurrence. VTE chemoprophylaxis in IVH appears safe and should not be delayed beyond standard care policies for ICH including when intraventricular catheter placement and thrombolytic therapy are performed.
脑出血后静脉血栓栓塞症（VTE）已得到充分研究，但自发性脑室内出血（IVH）患者的数据有限。
研究与 VTE 相关的因素、VTE 与 IVH 临床结局的关系，以及在接受脑室内导管和溶栓治疗的 IVH 患者中使用 VTE 化学预防的安全性。
对 CLEAR III 试验中的患者进行回顾性队列研究，该试验是一项多中心、随机试验，比较了脑室外引流与脑室内注射阿替普酶与安慰剂治疗梗阻性 IVH 的效果。预测变量是第 30 天内发生的 VTE。主要结局是与 VTE 相关的因素以及 6 个月时的死亡/严重残疾（改良 Rankin 评分 4-6）。
在 500 例 IVH 患者中，59 例（11.8%）在第 30 天内发生 VTE。在 412 例（82.4%）患者中启动了 VTE 化学预防，但只有在 401 例（80.2%）患者中在 IVH 发病后中位数为 4 天（四分位距，1-8）前进行了诊断，并且与颅内出血或导管路径出血无关。在多变量逻辑回归分析中，30 天内感染（比值比，1.80；95%置信区间，1.03-3.17）与 VTE 发生的几率增加显著相关。在 72 小时后开始 VTE 化学预防还与第一周后的 VTE 发生相关。
感染和延迟及时开始 VTE 化学预防与 VTE 发生相关。IVH 中的 VTE 化学预防似乎是安全的，不应延迟超过脑出血的标准治疗方案，包括放置脑室内导管和溶栓治疗时。
