Spruegel, Maximilian I., Sembill, Jochen A. ORCID: 0000-0003-0014-3389, Kuramatsu, Joji B., Gerner, Stefan T., Hagen, Manuel, Roeder, Sebastian S., Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Ringleb, Peter Arthur, Purrucker, Jan Christoph, Rizos, Timolaos, Volkmann, Jens, Muellges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, Erbguth, Frank, Nueckel, Martin, Schellinger, Peter D., Glahn, Joerg, Knappe, Ulrich J., Fink, Gereon Rudolf, Dohmen, Christian, Stetefeld, Henning, Fisse, Anna Lena, Minnerup, Jens, Hagemann, Georg, Rakers, Florian, Reichmann, Heinz, Schneider, Hauke ORCID: 0000-0002-9641-0922, Woepking, Sigrid, Ludolph, Albert C., Stosser, Sebastian, Neugebauer, Hermann ORCID: 0000-0003-3759-356X, Roether, Joachim, Michels, Peter, Schwarz, Michael, Reimann, Gernot, Baezner, Hansjoerg, Schwert, Henning, Classen, Joseph ORCID: 0000-0001-7182-6967, Michalski, Dominik, Grau, Armin, Palm, Frederick, Urbanek, Christian, Woehrle, Johannes C., Alshammari, Fahid, Horn, Markus, Bahner, Dirk, Witte, Otto W., Guenther, Albrecht, Hamann, Gerhard F., Luecking, Hannes, Doerfler, Arnd, Schwab, Stefan and Huttner, Hagen B. (2019). Heparin for prophylaxis of venous thromboembolism in intracerebral haemorrhage. J. Neurol. Neurosurg. Psychiatry, 90 (7). S. 783 - 792. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-330X

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Abstract

Objective To determine the occurrence of intracranial haemorrhagic complications (IHC) on heparin prophylaxis (low-dose subcutaneous heparin, LDSH) in primary spontaneous intracerebral haemorrhage (ICH) (not oral anticoagulation-associated ICH, non-OAC ICH), vitamin K antagonist (VKA)-associated ICH and non-vitamin K antagonist oral anticoagulant (NOAC)associated ICH. Methods Retrospective cohort study (RETRACE) of 22 participating centres and prospective single-centre study with 1702 patients with VKA-associated or NOAC-associated ICH and 1022 patients with non-OAC-ICH with heparin prophylaxis between 2006 and 2015. Outcomes were defined as rates of IHC during hospital stay among patients with non-OAC-ICH, VKA-ICH and NOAC-ICH, mortality and functional outcome at 3 months between patients with ICH with and without IHC. Results IHC occurred in 1.7% (42/2416) of patients with ICH. There were no differences in crude incidence rates among patients with VKA-ICH, NOAC-ICH and non-OAC-ICH (log-rank p=0.645; VKA-ICH: 27/1406 (1.9%), NOAC-ICH 1/130 (0.8%), non-OAC-ICH 14/880 (1.6%); p=0.577). Detailed analysis according to treatment exposure (days with and without LDSH) revealed no differences in incidence rates of IHC per 1000 patient-days (LDSH: 1.43 (1.04-1.93) vs non-LDSH: 1.32 (0.33-3.58), conditional maximum likelihood incidence rate ratio: 1.09 (0.38-4.43); p=0.953). Secondary outcomes showed differences in functional outcome (modified Rankin Scale=4-6: IHC: 29/37 (78.4%) vs non-IHC: 1213/2048 (59.2%); p=0.019) and mortality (IHC: 14/37 (37.8%) vs non-IHC: 485/2048 (23.7%); p=0.045) in disfavour of patients with IHC. Small ICH volume (OR: volume <4.4 mL: 0.18 (0.04-0.78); p=0.022) and low National Institutes of Health Stroke Scale (NIHSS) score on admission (OR: NIHSS <4: 0.29 (0.11-0.78); p=0.014) were significantly associated with fewer IHC. Conclusions Heparin administration for venous thromboembolism (VTE) prophylaxis in patients with ICH appears to be safe regarding IHC among non-OAC-ICH, VKA-ICH and NOAC-ICH in this observational cohort analysis. Randomised controlled trials are needed to verify the safety and efficacy of heparin compared with other methods for VTE prevention.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Spruegel, Maximilian I.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sembill, Jochen A.UNSPECIFIEDorcid.org/0000-0003-0014-3389UNSPECIFIED
Kuramatsu, Joji B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gerner, Stefan T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagen, ManuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roeder, Sebastian S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Endres, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haeusler, Karl GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sobesky, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schurig, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zweynert, SarahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bauer, MiriamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vajkoczy, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ringleb, Peter ArthurUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Purrucker, Jan ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rizos, TimolaosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Volkmann, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muellges, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kraft, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schubert, Anna-LenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Erbguth, FrankUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nueckel, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schellinger, Peter D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Glahn, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Knappe, Ulrich J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fink, Gereon RudolfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dohmen, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stetefeld, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fisse, Anna LenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Minnerup, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagemann, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rakers, FlorianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reichmann, HeinzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schneider, HaukeUNSPECIFIEDorcid.org/0000-0002-9641-0922UNSPECIFIED
Woepking, SigridUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ludolph, Albert C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stosser, SebastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neugebauer, HermannUNSPECIFIEDorcid.org/0000-0003-3759-356XUNSPECIFIED
Roether, JoachimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Michels, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwarz, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reimann, GernotUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baezner, HansjoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwert, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Classen, JosephUNSPECIFIEDorcid.org/0000-0001-7182-6967UNSPECIFIED
Michalski, DominikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grau, ArminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Palm, FrederickUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Urbanek, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Woehrle, Johannes C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alshammari, FahidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Horn, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bahner, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Witte, Otto W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guenther, AlbrechtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hamann, Gerhard F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Luecking, HannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Doerfler, ArndUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwab, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huttner, Hagen B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-137024
DOI: 10.1136/jnnp-2018-319786
Journal or Publication Title: J. Neurol. Neurosurg. Psychiatry
Volume: 90
Number: 7
Page Range: S. 783 - 792
Date: 2019
Publisher: BMJ PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 1468-330X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ATRIAL-FIBRILLATION; ANTICOAGULATION; PREVENTION; THROMBOSIS; STROKE; RISK; METAANALYSIS; RESUMPTION; WARFARIN; SAFETYMultiple languages
Clinical Neurology; Psychiatry; SurgeryMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13702

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