Abstract 209: Association Between Pharmacologic Thromboprophylaxis and Hemorrhage Progression in Patients With Hemorrhagic Stroke

Abstract

Background: There is scant evidence on the safety of pharmacologic thromboprophylaxis (PTP) after hemorrhagic stroke. We sought to assess the association between PTP use and hemorrhage progression in patients who were diagnosed with primary hemorrhagic stroke. Methods: We reviewed patients with non-traumatic/spontaneous subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) from 1/2010 - 12/2012. We examined hemorrhage progression in two populations: patients with a stable initial f/u CT (no progression within one day of admission), and patients with an unstable initial f/u CT. Multivariate stepwise logistic regression was used to examine the association between hemorrhage progression and PTP. Results: In the 245 patients identified, 117 (48%) experienced hemorrhage progression. In the sub-group with unstable initial f/u CT (n=79, 32%) 24 patients (30%) had subsequent hemorrhage progression. Only one patient with an unstable initial f/u CT received PTP; thus, the association between PTP and subsequent hemorrhage progression was not analyzed further. Only SAH was independently associated with subsequent hemorrhage progression (OR: 4.3, p=0.03). In the sub-group with stable initial f/u CT (n=166, 68%), 38 patients (23%) had later hemorrhage progression; the rates of hemorrhage progression were similar for patients who received PTP and those who did not (26% vs. 22%, p=0.54). Variables that were independently associated with hemorrhage progression in the stable initial f/u CT group include non-ambulatory status (OR: 7.8, p=0.002), minor stroke (NIHSS<8, OR: 4.1, p=0.02), male gender (OR: 4.4, p= 0.01), and hospital LOS (OR: 1.1/day, p< 0.001); receiving PTP was not a predictor (OR: 0.6, p=0.42). Conclusions: This study demonstrated that in patients whose initial f/u CT was stable, the use of PTP was not associated with an increased risk of hemorrhage progression. There was insufficient evidence to determine the relationship between PTP and subsequent progression in the unstable f/u CT population. These data suggest that PTP may be safe in patients with hemorrhagic stroke whose initial f/u CT is stable.