1Faculty of Medicine and.
2Department of Neurosurgery, Neuroscience Centre Siloam Hospital, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia.
Neurosurg Focus. 2022 Mar;52(3):E9. doi: 10.3171/2021.12.FOCUS21419.
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.
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.
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.
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.
蛛网膜下腔出血（SAH）后发生的血管痉挛及其导致的梗死仍然是最具破坏性的并发症。目前的治疗选择有限，尼莫地平是唯一被批准的预防用药。肝素除了具有抗凝特性外，还具有多效性和抗炎作用，这可能对血管痉挛有益。在这项研究中，作者试图评估肝素治疗 SAH 的疗效和安全性。
在 PubMed、EBSCOhost、Europe PMC 和 Cochrane Central 数据库中进行检索，以找到包括接受动脉瘤夹闭术后接受静脉注射普通肝素（UFH）治疗的 SAH 患者的研究。排除未与 UFH 或低分子量肝素在深静脉血栓预防剂量下进行比较的研究。主要结局是血管痉挛，次要结局是脑梗死、由迟发性脑缺血引起的临床恶化、出血并发症和血栓栓塞并发症。
共纳入 5 项非随机研究；其中 4 项研究评估了安全性，3 项研究评估了静脉肝素的疗效。从总共 895 例患者的 3 项研究的分析来看，静脉 UFH 给药 > 48 小时与脑梗死发生率显著降低相关（OR 0.44，95%CI 0.25-0.79）。与其他疗效结果无显著关联。关于认知结果，一项研究发现蒙特利尔认知评估评分有显著改善；然而，肝素给药并未改善改良 Rankin 量表评分所示的功能结局。从总共 1099 例患者的 4 项研究的分析来看，未发现出血和其他并发症显著增加。
静脉 UFH 给药超过 48 小时可降低脑梗死发生率，且安全性良好。这一结果支持正在进行的临床试验。
