Heparin for prophylaxis of venous thromboembolism in intracerebral haemorrhage

What is it about?

Patients with intracerebral hemorrhage (ICH) have a high risk of thromboembolic complications. Although low-dose subcutaneous heparins (LDSH) are referred to as a second line treatment for prophylaxis of venous thromboembolism (VTE), their safety concerning bleeding complications remains to be verified. The present German-wide multicenter study pooled individual data of 22 participating centers. Intracranial hemorrhagic complications (IHC) occurred in 1.7% (42/2,416) of ICH patients without differences between primary spontaneous ICH (non-OAC-ICH), vitamin K antagonist (VKA-) and non-vitamin K antagonist oral anticoagulant (NOAC-) associated ICH. Detailed analysis according to treatment exposure (days with and without LDSH) revealed no differences in incidence-rates of IHC per 1,000 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). Therefore, heparin administration for VTE prophylaxis in ICH patients appears to be safe regarding intracranial hemorrhagic complications among non-OAC-ICH, VKA-ICH and NOAC-ICH in this observational cohort analysis. The general safety and efficacy of low dose heparins, as compared to other methods for VTE prevention, still needs to be established for ICH patients in randomized controlled trials.

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