Is there a role for heparin in the management of complications of subarachnoid hemorrhage?

Proven effective therapy to prevent ischemic deficits and other complications after subarachnoid hemorrhage is lacking despite extensive research efforts. A literature review documented both clinical and experimental evidence suggesting that heparin may be effective in preventing ischemic deficits after subarachnoid hemorrhage by reversing vasospasm, improving blood flow through narrowed vessels, and preventing the development of a proliferative angiopathy. Additional evidence suggests that heparinization of the cerebrospinal fluid following subarachnoid hemorrhage may prevent the development of hydrocephalus. In the only clinical trial using heparin after subarachnoid hemorrhage, the incidence of rebleeding in the heparinized patients was no higher than in the control group. We conclude that the existing preliminary data concerning a role for heparin in the management of the complications of subarachnoid hemorrhage is promising, but further controlled studies are needed prior to clinical application.