Abstract 208: Pharmocologic Thromboprophylaxis Reduces the Odds of Venous Thromboembolism in Patients With Hemorrhagic Stroke

Abstract

Background: Current guidelines regarding the use and optimal timing of Pharmacologic Thromboprophylaxis (PTP) are unclear in patients with primary diagnosis of hemorrhagic stroke. We sought to determine the association between PTP and development of venous thromboembolism (VTE) in this population. Methods: We reviewed patients with non-traumatic/spontaneous subarachnoid hemorrhage and intracerebral hemorrhage admitted between 1/2010-12/2012 with hospital LOS ≥ 3 d (n=245). Multivariate stepwise logistic regression was used to analyze the association between PTP and development of VTE. PTP was analyzed in regards to: use of PTP (vs. not administered), early administration of PTP (vs. ≥ 72 h) and interruption of PTP (vs. continuous use). The following covariates were considered: primary diagnosis, age, gender, transfer status, pre-event warfarin use, overweight/obese (BMI ≥ 25), ambulation ≥ 100 feet, IVC filter placement, moderate/severe stroke (NIHSS ≥ 8), Glasgow Coma Score (GCS 3-8, 9-12, 13-15), hospital LOS and ICU LOS. Results: The overall incidence of VTE was11.4% (28/245). All but 4 patients (98.4%) received mechanical prophylaxis; however, only one-third of patients (n=81) received PTP, and was initiated early in a minority (9.9%, n=8). The incidence of VTE was not significantly different in patients who received PTP (7.3%, 5/69) compared to patients who did not receive PTP (13.1%, 23/176), before adjustment (OR: 0.52, p = 0.20). However, after adjustment for age, gender, pre-event warfarin use, ambulation, and ICU LOS, PTP was associated with significantly reduced odds of VTE (OR: 0.05 (0.01 - 0.31), p = 0.001). Age ≥ 65 (5.73 (1.17 - 28.19), p = 0.03) and prolonged ICU LOS (1.29 (1.16 - 1.44), p < 0.001) were associated with increased odds of VTE. Neither the timing nor the interruption of PTP was associated with development of VTE. Conclusions: This study demonstrated that the odds of developing VTE were 95% lower in patients receiving PTP. We recommend the use of PTP in addition to mechanical thromboprophylaxis in patients with stable hemorrhagic stroke. The exact timing of beginning such chemoprophylaxis needs better definition.