Abstract T MP83: Comparison of Pharmacologic versus Mechanical Venous Thromboemoblism Prophylaxis in Patients with Intracranial Hemorrhage

Abstract

Introduction: The use of pharmacologic venous thromboembolism (VTE) prophylaxis in patients with acute intracranial hemorrhage has been controversial due to concerns of hemorrhage expansion. We hypothesize that pharmacologic VTE prophylaxis is associated with better functional outcomes, without excess bleeding risk, compared to mechanical prophylaxis alone. METHODS: In a prospective study of intracranial hemorrhage patients (SAH N=116; intracerebral hemorrhage N=125 and subdural hemorrhage N=130) conducted between 7/2008-11/2011, we compared bleeding complications, VTE rates and 3-month functional outcomes between patients who received pharmacologic VTE prophylaxis (either heparin or enoxaparin) plus compression boots versus mechanical prophylaxis (compression boots) alone. RESULTS: Of 371 patients, 265 (70%) received pharmacologic prophylaxis in addition to compression boots, while 106 (29%) received compression boots alone. The median time to initiation of pharmacological prophylaxis was 4 days post hemorrhage onset and 2 days from surgical intervention, while mechanical prophylaxis was started at hospital admission. Compared to mechanical prophylaxis alone, those who received pharmacologic prophylaxis were younger (median age 60 versus 69, P=0.002), more likely to have a SAH (41% versus 8%, P<0.0001), less likely to have SDH (25% versus 60%, P<0.0001) and less likely to be DNR/comfort care (14% versus 27%, P<0.0001). Admission GCS and APACHE 2 scores did not vary between groups. ICH expansion was less common in those receiving pharmacologic prophylaxis (7% versus 2%; P=0.030) and there were no differences in other bleeding events (EVD associated hemorrhage, new ICH, new SDH, SDH reaccumulation, bleeding at the craniotomy site, GI bleeding or anemia requiring transfusion) or thombotic events (DVT or PE). Pharmacologic prophylaxis was significantly protective against death at 3 months after adjusting for age, admission GCS, bleed type, and DNR/comfort care status (aOR 0.2, 95% CI 0.1-0.5, P<0.0001). CONCLUSIONS: In intracranial hemorrhage patients, pharmacological VTE prophylaxis is not associated with higher bleeding risks and predicts improved 3-month mortality rates compared to mechanical VTE prophylaxis alone.