Choi Jongwook, Koo Younmoo, Whang Kum, Cho Sungmin, Kim Jongyeon
Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 26426, Republic of Korea.
Clin Neurol Neurosurg. 2021 Feb;201:106453. doi: 10.1016/j.clineuro.2020.106453. Epub 2020 Dec 29.
Of the complications that can occur during endovascular surgery in aneurysmal subarachnoid hemorrhage (aSAH) patients, thromboembolism remains a particular challenge for many surgeons. Heparin has been widely used for its prevention, but it has not been able to eliminate concerns about bleeding. Therefore, in this study, we tried to determine the risk of rebleeding associated with heparin use.
We retrospectively analyzed the medical and surgical records of 109 patients that underwent endovascular embolization for a ruptured cerebral aneurysm at a single institution from 2010 to 2014. These patients were divided into two groups according to whether heparin was loaded or not, to determine the effect of heparin on rebleeding and to identify other risk factors of rebleeding.
This series included 40 men (36.7 %) and 69 women (63.3 %) of mean age 57.9 ± 14.8 years. In 80 patients (73.4 %), endovascular embolization was conducted using an intraoperative bolus of 5000 units of heparin, whereas in the other 29 (26.6 %) endovascular embolization was performed without an intraoperative heparin bolus. After procedures, 16 patients (14.7 %) experienced rebleeding and 2 (1.8 %) a thromboembolic event. Intraoperative heparin loading (OR 0.683 [95 % CI 0.199-2.338]) was not found to be related to postoperative rebleeding. Rather, logistic regression analysis showed preoperative modified Fisher grade (OR 2.037 [95 % CI 1.077-3.853]) and external ventricular drainage (OR 5.389 [95 % CI 1.171-24.801]) independently predicted rebleeding.
Heparin loading during endovascular treatment of ruptured cerebral aneurysms did not affect rebleeding. We conclude heparin loading to prevent thromboembolism during endovascular treatment may be considered a good option in aSAH patients.
在动脉瘤性蛛网膜下腔出血（aSAH）患者的血管内手术过程中可能出现多种并发症，血栓栓塞对许多外科医生来说仍是一项特殊挑战。肝素已被广泛用于预防血栓栓塞，但它未能消除对出血的担忧。因此，在本研究中，我们试图确定与使用肝素相关的再出血风险。
我们回顾性分析了2010年至2014年在单一机构接受破裂脑动脉瘤血管内栓塞治疗的109例患者的医疗和手术记录。根据是否使用肝素负荷剂量，将这些患者分为两组，以确定肝素对再出血的影响，并识别再出血的其他危险因素。
该系列包括40名男性（36.7%）和69名女性（63.3%），平均年龄57.9±14.8岁。80例患者（73.4%）在血管内栓塞术中使用了5000单位肝素的术中推注剂量，而其他29例患者（26.6%）在血管内栓塞术中未使用术中肝素推注剂量。术后，16例患者（14.7%）发生再出血，2例患者（1.8%）发生血栓栓塞事件。未发现术中肝素负荷剂量（比值比0.683[95%可信区间0.199 - 2.338]）与术后再出血有关。相反，逻辑回归分析显示术前改良Fisher分级（比值比2.037[95%可信区间1.077 - 3.853]）和脑室外引流（比值比5.389[95%可信区间1.171 - 24.801]）可独立预测再出血。
破裂脑动脉瘤血管内治疗期间使用肝素负荷剂量不影响再出血。我们得出结论，在aSAH患者的血管内治疗期间使用肝素负荷剂量预防血栓栓塞可能是一个不错的选择。
