Abstract T P236: Safety of Venous Thromboembolism Prophylaxis in Intracranial Hemorrhage Patients with External Ventricular Drains

Abstract

Introduction: Despite high rates of venous thromboembolism (VTE) among critically ill patients with intracranial hemorrhage, there is a reluctance to use pharmacologic VTE prophylaxis in patients with external ventricular drains (EVD) due to concerns of procedure site hemorrhage. METHODS: In a prospective study of intracranial hemorrhage patients with an EVD (subarachnoid hemorrhage N=64; intracerebral hemorrhage N=41 and subdural hemorrhage N=5) 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 110 patients with an EVD, 98 (89%) received pharmacologic prophylaxis (heparin BID N=3 [3%]; heparin TID N= 34 [31%]; enoxaparin N=61 [56%]) in addition to compression boots, while 11 (11%) received compression boots alone. The median time to initiation of pharmacological prophylaxis was 4 days post hemorrhage. Compared to mechanical prophylaxis alone, pharmacologic prophylaxis patients were more likely to have SAH (60% versus 22%, P=0.028), less likely to have SDH (2% versus 33%, P<0.0001) and less likely to be DNR/comfort care (19% versus 44%, P=0.035). Admission GCS and APACHE 2 scores did not differ between groups. There were no significant differences in bleeding events (EVD associated hemorrhage, ICH expansion, new ICH, new SDH, SDH reaccumulation, bleeding at the craniotomy site, GI bleeding or anemia requiring transfusion) or thombotic events (DVT or PE) between groups. At 3-months, fewer patients receiving pharmacologic prophylaxis were dead (25% versus 67%, P=0.012) or severely disabled (51% versus 89%, P=0.049). After adjusting for admission GCS, age, DNR status, and bleed type this trend for reduced 3-month mortality remained (adjust OR 0.1, 95%CI 0.004-1.2,P=0.065). CONCLUSIONS: In intracranial hemorrhage patients with EVDs, pharmacological VTE prophylaxis is not associated with higher bleeding risks and is associated with improved 3-month mortality rates compared to mechanical VTE prophylaxis alone.