scholarly journals Patients with venous thromboembolism after spontaneous intracerebral hemorrhage: a review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Qiyan Cai ◽  
Xin Zhang ◽  
Hong Chen

Abstract Background Patients with spontaneous intracerebral hemorrhage (ICH) have a higher risk of venous thromboembolism (VTE) and in-hospital VTE is independently associated with poor outcomes for this patient population. Methods A comprehensive literature search about patients with VTE after spontaneous ICH was conducted using databases MEDLINE and PubMed. We searched for the following terms and other related terms (in US and UK spelling) to identify relevant studies: intracerebral hemorrhage, ICH, intraparenchymal hemorrhage, IPH, venous thromboembolism, VTE, deep vein thrombosis, DVT, pulmonary embolism, and PE. The search was restricted to human subjects and limited to articles published in English. Abstracts were screened and data from potentially relevant articles was analyzed. Results The prophylaxis and treatment of VTE are of vital importance for patients with spontaneous ICH. Prophylaxis measures can be mainly categorized into mechanical prophylaxis and chemoprophylaxis. Treatment strategies include anticoagulation, vena cava filter, systemic thrombolytic therapy, catheter-based thrombus removal, and surgical embolectomy. We briefly summarized the state of knowledge regarding the prophylaxis measures and treatment strategies of VTE after spontaneous ICH in this review, especially on chemoprophylaxis and anticoagulation therapy. Early mechanical prophylaxis, especially with intermittent pneumatic compression, is recommended by recent guidelines for patients with spontaneous ICH. While decision-making on chemoprophylaxis and anticoagulation therapy evokes debate among clinicians, because of the concern that anticoagulants may increase the risk of recurrent ICH and hematoma expansion. Uncertainty still exists regarding optimal anticoagulants, the timing of initiation, and dosage. Conclusion Based on current evidence, we deem that initiating chemoprophylaxis with UFH/LMWH within 24–48 h of ICH onset could be safe; anticoagulation therapy should depend on individual clinical condition; the role of NOACs in this patient population could be promising.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1288-1288 ◽  
Author(s):  
Manmeet S Ahluwalia ◽  
Kimberly Klein ◽  
Boris W Kuvshinoff ◽  
Francisco J. Hernandez-Ilizaliturri ◽  
Gregory Wilding ◽  
...  

Abstract Background: Venous thromboembolism (VTE) is reported in about five percent of patients with malignancy and is often associated with serious clinical outcomes such as major infarction, hemorrhage and death. The prevalence rates of malignancy-related VTE is most likely underestimated, in part because of the frequent presence of confounding risk factors, such as advanced age, prolonged immobilization, surgical procedures, and chemotherapeutic regimens. Occurrence of VTE can increase the likelihood of death for cancer patients by 2- to 8-fold. Prophylactic anticoagulation therapy and mechanical prophylaxis is recommended for all inpatients with a diagnosis of active malignancy. Mechanical prophylaxis alone is recommended for patients if contraindication to anticoagulation therapy exists. Roswell Park Cancer Institute (RPCI), a Comprehensive Cancer Center with 24,000 active patients under its care, initiated an Institute-Wide Quality Improvement Initiative in 2006 to improve the rates of VTE prophylaxis for all adult inpatient admissions. The objectives were to improve compliance with national guidelines on VTE prophylaxis and to reduce future VTE events in our patient population. Methods: VTE prophylaxis based on National Comprehensive Cancer Network (NCCN) guidelines was instituted on all Medical services. Surgical services followed guidelines in accordance with NCCN and Surgical Best Practice and published standards. Mandatory physician order entry forms including computerized physician order entry were implemented. VTE awareness and staff education was promoted via informational materials, field in-services and seminars. In order to track compliance, manual audits of patient charts were performed every 3 months. Results: Results: Initial surveys revealed 61% compliance with guidelines on the medicine service and 86% on the surgical services. Overall institute-wide VTE Prophylaxis compliance improved from 80% to 95% following implementation of the initiative (shown in table 1). This has resulted in a decrease in VTE incidence from 0.39% in the last quarter of 2006 when the initiative was launched to 0.13% and 0.08% seen in the first and second quarters of 2008 respectively (P<0.0001). The actual events dropped from 40 in the last quarter of 2006 to 14 events and 10 events in the first and the second quarter of 2008 respectively. The greatest benefit was seen in reduction in outpatient VTE and on the medical services. Conclusions: Implementation of our VTE Prophylaxis Initiative resulted in improved compliance with national guidelines at RPCI and has resulted in a highly significant and clinically relevant reduction of VTE in our vulnerable patient population. Table 1: Institute Compliance rate on VTE prophylaxis 2006 2007 2008 Compliance Q4 Q1 Q2 Q3 Q4 Q1 Q2 Medical Services 61% 78% 86% 95% 96% 90% 90% Surgical Service 86% 92% 98% 98% 97% 97% 100% Institute-Wide 80.40% 86.80% 93.60% 96.60% 96.50% 94.60% 95.4% Table 2: VTE events 2006 2007 2008 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 # VTE/Quarter 31 30 40 40 38 29 34 17 14 10 # Admission/Outpatients 10439 11518 10367 10298 10230 11072 10815 11852 10887 13234 % 0.30% 0.26% 0.39% 0.39% 0.37% 0.26% 0.31% 0.14% 0.13% 0.08%


2021 ◽  
Vol 61 ◽  
pp. 177-185
Author(s):  
Andrea Loggini ◽  
Faten El Ammar ◽  
Ali Mansour ◽  
Christopher L. Kramer ◽  
Fernando D. Goldenberg ◽  
...  

2017 ◽  
Vol 34 (1) ◽  
pp. 37 ◽  
Author(s):  
AmirA Elsaeed Egila ◽  
RizkM Khodair ◽  
MagedK Faheem ◽  
ShaimaaM Kasem

EBioMedicine ◽  
2019 ◽  
Vol 43 ◽  
pp. 454-459 ◽  
Author(s):  
Jinjin Liu ◽  
Haoli Xu ◽  
Qian Chen ◽  
Tingting Zhang ◽  
Wenshuang Sheng ◽  
...  

2020 ◽  
Vol 81 (03) ◽  
pp. 253-260
Author(s):  
Xi Pan ◽  
Jihui Li ◽  
Lan Xu ◽  
Shengming Deng ◽  
Zhi Wang

Abstract Objectives Patients with spontaneous intracerebral hemorrhage (sICH) have a nearly fourfold greater risk for venous thromboembolism (VTE) than those with acute ischemic stroke, and VTE after sICH is associated with high risk for in-hospital mortality. The benefit from prophylactic heparin for VTE remains uncertain because its safety is not documented. In this study, we used an updated meta-analysis to evaluate the safety of heparin for the prevention of VTE in patients with sICH. Methods Electronic databases Medline and Embase from January 1990 to November 2017 and the Cochrane Library were searched using these keywords: intracerebral hemorrhage, stroke, hemorrhagic stroke, subarachnoid hemorrhage, heparin, heparinoids, low-molecular-weight heparin, anticoagulants, prophylactic, low dose, prevention, deep venous thrombosis, pulmonary embolism, venous thrombosis, randomized controlled trial, controlled clinical trial, and outcome. We evaluated the quality of included studies according to the bias risk in the Cochrane Handbook for Systematic Reviews of Interventions v.5.1.0. All statistical analyses were performed with RevMan v.5 software (Cochrane Collaboration, London, United Kingdom). Tests of heterogeneity were conducted with the Mantel-Haenszel method. Results Nine studies involving 4,055 patients with sICH met the inclusion criteria in this meta-analysis. Of these studies, only one met all specific criteria and had a low probability of bias, whereas eight studies met only some of the criteria and had a moderate probability of bias. In comparison with non-heparin treatments, low-molecular-weight heparin or unfractionated heparin was associated with a nonsignificant increase in any hematoma enlargement, a nonsignificant reduction in extracranial hemorrhage, a nonsignificant increase in mortality, a nonsignificant increase in the number of modified Rankin Scale scores of 3 to 5, and a nonsignificant increase in numbers of Glasgow Outcome Scale scores of 2 to 3. Conclusion Prophylactic heparin was associated with a nonsignificant increase in any hematoma enlargement and mortality, a nonsignificant reduction in extracranial hemorrhage, and a nonsignificant increase in the incidence of major disability in patients with sICH. It is probably safe to administer heparin to prevent VTE in patients with sICH.


2010 ◽  
Vol 48 (5) ◽  
pp. 399 ◽  
Author(s):  
Soo Yong Park ◽  
Min Ho Kong ◽  
Jung Hee Kim ◽  
Dong Soo Kang ◽  
Kwan Young Song ◽  
...  

2008 ◽  
Vol 69 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Jae Kwan Lim ◽  
Hyung Sik Hwang ◽  
Byung Moon Cho ◽  
Ho Kook Lee ◽  
Sung Ki Ahn ◽  
...  

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