Laurent Dimitri, Bardhi Olgert, Kubilis Paul, Corliss Brian, Adamczak Stephanie, Geh Ndi, Dodd William, Vaziri Sasha, Busl Katharina, Fox W Christopher
Department of Neurosurgery, Lillian S. Wells, University of Florida, Florida, United States.
Department of Neurology, University of Florida, Gainesville, Florida, United States.
Surg Neurol Int. 2021 Jun 14;12:277. doi: 10.25259/SNI_100_2021. eCollection 2021.
Spontaneous intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. The development of venous thromboembolism (VTE), including deep venous thrombosis or pulmonary embolism, is correlated with negative outcomes following ICH. Due to the risk of hematoma expansion associated with the use of VTE chemoprophylaxis, there remains significant debate about the optimal timing for its initiation following ICH. We analyzed the risk of early chemoprophylaxis on hematoma expansion following ICH.
We performed a retrospective analysis of patients presenting with spontaneous ICH at single institution between 2011 and 2018. The rate of hematoma expansion was compared between patients that received early chemoprophylaxis (on admission) and those that received conventional chemoprophylaxis (>24 h).
Data for 235 patients were available for analysis. Eleven patients (7.5%) in the early prophylaxis cohort and seven patients (8.0%) in the conventional prophylaxis cohort developed VTE ( = 0.9). Hematoma expansion also did not differ significantly (early 19%, conventional 23%, = 0.5).
The use of early chemoprophylaxis against venous thromboembolic events following ICH appears safe in our patient population without increasing the risk of hematoma expansion. Given the increased risk of poor outcome in the setting of VTE, early VTE chemoprophylaxis should be considered in patients who present with ICH. Larger, prospective, and randomized studies are necessary to better elucidate the risk of early chemoprophylaxis and potential reduction in venous thromboembolic events.
自发性脑出血（ICH）是全球发病和死亡的重要原因。静脉血栓栓塞症（VTE）的发生，包括深静脉血栓形成或肺栓塞，与脑出血后的不良预后相关。由于使用VTE化学预防措施存在血肿扩大的风险，关于脑出血后开始使用VTE化学预防措施的最佳时机仍存在重大争议。我们分析了早期化学预防对脑出血后血肿扩大的风险。
我们对2011年至2018年在单一机构就诊的自发性脑出血患者进行了回顾性分析。比较了接受早期化学预防（入院时）的患者和接受传统化学预防（>24小时）的患者的血肿扩大率。
有235例患者的数据可供分析。早期预防队列中有11例患者（7.5%）发生VTE，传统预防队列中有7例患者（8.0%）发生VTE（P=0.9）。血肿扩大情况也无显著差异（早期为19%，传统组为23%，P=0.5）。
在我们的患者群体中，脑出血后早期使用化学预防措施预防静脉血栓栓塞事件似乎是安全的，不会增加血肿扩大的风险。鉴于VTE情况下不良结局风险增加，对于脑出血患者应考虑早期进行VTE化学预防。需要进行更大规模、前瞻性和随机研究，以更好地阐明早期化学预防的风险以及静脉血栓栓塞事件的潜在减少情况。
