Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA.
J Intensive Care Med. 2024 Sep;39(9):895-899. doi: 10.1177/08850666241242683. Epub 2024 Mar 26.
Venous thromboembolism (VTE) is a common but preventable complication observed in critically ill patients. Deep vein thrombosis (DVT) is the most common type of VTE, with clinical significance based on location and symptoms. There is an increased incidence of DVT and pulmonary embolism (PE) in ischemic stroke patients using unfractionated heparin (UFH) for VTE prophylaxis compared with those using enoxaparin. However, UFH is still used in some patients due to its perceived safety, despite conflicting literature suggesting that enoxaparin may have a protective effect. The current study aimed to determine the incidence of VTEs in patients with acute ischemic strokes on UFH versus enoxaparin for VTE prophylaxis, subclassifying the VTEs depending on their location and symptoms. It also aimed to examine the safety profile of both drugs. A total of 909 patients admitted to the Neuro-ICU with the diagnosis of acute ischemic stroke were identified, and 634 patients were enrolled in the study-170 in the enoxaparin group and 464 in the UFH group-after applying the exclusion criteria. Nineteen patients in the UFH group (4.1%) and 3 patients in the enoxaparin group (1.8%) had a VTE. The incidence of DVT in the UFH group was 12 (2.6%), all of which were symptomatic, compared with 3 (1.8%) in the enoxaparin group, wherein one case was symptomatic. Nine patients (1.9%) in the UFH group developed a PE during the study period, and all of them were symptomatic. No patients in the enoxaparin group developed PE. No statistically significant difference was found between both groups. However, 18 patients in the UFH group (3.9%) experienced intracranial hemorrhage compared with none in the enoxaparin group, and this difference was statistically significant. Enoxaparin was found to be as effective as and potentially safer than UFH when used for VTE prophylaxis in stroke patients.
静脉血栓栓塞症（VTE）是危重症患者中常见但可预防的并发症。深静脉血栓形成（DVT）是最常见的 VTE 类型，其临床意义取决于位置和症状。与使用依诺肝素（UFH）预防 VTE 的缺血性脑卒中患者相比，使用依诺肝素的患者发生 DVT 和肺栓塞（PE）的发生率更高。然而，由于 UFH 被认为更安全，尽管有相互矛盾的文献表明依诺肝素可能具有保护作用，但仍在一些患者中使用 UFH。本研究旨在确定使用 UFH 与依诺肝素预防 VTE 的急性缺血性脑卒中患者中 VTE 的发生率，根据其位置和症状对 VTE 进行分类，并检查两种药物的安全性概况。共确定了 909 例因急性缺血性脑卒中入住神经 ICU 的患者，符合纳入标准的患者为 634 例-依诺肝素组 170 例，UFH 组 464 例-应用排除标准后。UFH 组有 19 例（4.1%）患者和依诺肝素组有 3 例（1.8%）患者发生 VTE。UFH 组 DVT 的发生率为 12 例（2.6%），均为症状性，而依诺肝素组为 3 例（1.8%），其中 1 例为症状性。在研究期间，UFH 组有 9 例（1.9%）患者发生 PE，均为症状性。依诺肝素组无患者发生 PE。两组间无统计学差异。然而，UFH 组有 18 例（3.9%）患者发生颅内出血，而依诺肝素组无患者发生颅内出血，差异有统计学意义。依诺肝素在预防脑卒中患者的 VTE 方面与 UFH 一样有效，且可能更安全。
