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Thromb Haemost 2022; 122(07): 1159-1168
DOI: 10.1055/s-0042-1744541
Stroke, Systemic or Venous Thromboembolism

Systematic Review and Meta-Analysis of Thromboprophylaxis with Heparins Following Intracerebral Hemorrhage

Gerald Chi 
1   Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Jane J. Lee
2   Department of Trial Design and Development, Baim Institute for Clinical Research, Boston, Massachusetts, United States
,
Shi Sheng
3   Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
,
Jolanta Marszalek
4   Department of Neurology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, United States
,
Michael L. Chuang
1   Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations Funding None.
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Abstract

Background The efficacy and safety of pharmacological thromboprophylaxis in patients with intracerebral hemorrhage (ICH) remains unclear.

Methods A literature search was performed to collect studies comparing the effect of thromboprophylaxis in patients with ICH. The primary endpoints were deep vein thrombosis (DVT), pulmonary embolism (PE), and hematoma expansion or rebleeding. A meta-analytic approach was employed to estimate the relative risk (RR) by fitting fixed-effects (FE) and random-effects (RE) models.

Results A total of 28 studies representing 3,697 hospitalized patients with ICH were included. Thromboprophylaxis was initiated within 4 days following hospital presentation and continued for 10 to 14 days in most of studies. Compared with control, thromboprophylaxis was associated with a reduced risk of DVT (47/1,399 [3.4%] vs. 202/1,377 [14.7%]; FE: RR, 0.24; 95% CI, 0.18–0.32; RE: RR, 0.27; 95% CI, 0.19–0.39) as well as PE (9/953 [0.9%] vs. 37/864 [4.3%]; FE: RR, 0.33; 95% CI, 0.19–0.57; RE: RR, 0.37; 95% CI, 0.21–0.66). Thromboprophylaxis was not associated with increased risk of hematoma expansion or rebleeding (32/1,319 [2.4%] vs. 37/1,301 [2.8%]; FE: RR, 0.75; 95% CI, 0.48–1.18; RE: RR, 0.80; 95% CI, 0.49–1.30) or mortality (117/925 [12.6%] vs. 139/904 [15.4%]; FE: RR, 0.82; 95% CI, 0.65–1.03; RE: RR, 0.83; 95% CI, 0.66–1.04).

Conclusion Thromboprophylaxis was effective in preventing DVT and PE without increasing the risk of hematoma expansion or bleeding among ICH patients. Future studies should explore the long-term effects of thromboprophylaxis in this population, particularly on the functional outcomes.

Keywords

intracerebral hemorrhage - hemorrhagic stroke - pulmonary embolism - heparin

Author Contributions

G.C. had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Conception and design: G.C., J.M. Acquisition, analysis, or interpretation of data: G.C., J.J.L., S.S., J.M., M.L.C. Drafting of the manuscript: G.C., J.J.L, S.S. Critical revision of the manuscript for important intellectual content: J.M., M.L.C. Statistical analysis: G.C. Supervision: M.L.C.


Supplementary Material



Publication History

Received: 31 July 2021

Accepted: 08 February 2022

Article published online:
19 June 2022

© 2022. Thieme. All rights reserved.

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Comment to this article:

Anticoagulation for Thromboprophylaxis in Patients with Intracerebral Hemorrhage: Less Room for SkepticismThromb Haemost 2022; 122(07): 1071-1074
DOI: 10.1055/a-1834-4923

 

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