Is Prophylactic anticoagulation for deep venous thrombosis common practice after intracerebral hemorrhage?

Shyam Prabhakaran*, Patricia Herbers, Jane Khoury, Opeolu Adeoye, Pooja Khatri, Simona Ferioli, Dawn O. Kleindorfer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

BACKGROUND AND PURPOSE - : Prophylactic anticoagulation for deep venous thrombosis prevention after intracerebral hemorrhage (ICH) is safe. Current guidelines recommend prophylactic anticoagulation after cessation of hematoma growth. We aimed to evaluate nationwide trends in deep venous thrombosis prophylaxis after ICH. METHODS - : In an analysis of the Premier database, we identified adult patients with ICH (International Classification of Diseases Ninth edition code 431) from 2006 to 2010 who survived to day 2 of hospitalization. We excluded those with trauma or who underwent craniotomy or angiography. We abstracted type of anticoagulant used and date of first administration. We used univariate statistics and multivariable logistic regression to assess factors associated with prophylactic anticoagulation after ICH. RESULTS - : Among 32 690 (mean age, 69.7 years; 50.1% men) patients with spontaneous ICH, 5395 (16.5%) patients received any prophylactic anticoagulation during the hospital stay. Among these patients, 2416 (44.8%) received prophylactic anticoagulation by day 2. The most commonly used agents were heparin (71.1%), enoxaparin (27.5%), and dalteparin (1.4%). The proportion of patients receiving prophylactic anticoagulation increased slightly during the study period from 14.3% to 18.0% (P<0.01 for trend). Use of prophylactic anticoagulation varied by geographic region (P<0.001) in the United States: Northeast (23.2%), South (19.0%), Midwest (10.8%), and West (9.8%). In multivariable analysis, geographic region remained an independent predictor of prophylactic anticoagulation. CONCLUSIONS - : Less than 20% of patients with ICH receive anticoagulation for deep venous thrombosis in the United States. When used, the time to initiation is <2 days in less than half of the patients. Further study should focus on understanding variations in practice and emphasize guideline-driven care.

Original languageEnglish (US)
Pages (from-to)369-375
Number of pages7
JournalStroke
Volume46
Issue number2
DOIs
StatePublished - 2015

Keywords

  • anticoagulants
  • pulmonary embolism
  • thromboembolism

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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