Abstract
Objective: The use of antiplatelet or anticoagulants has previously been shown to increase hemorrhagic complications of ventricular catheterization. Although heparin use 24 h after ventriculostomy appears safe, the safety of heparin immediately (within 4 h) after ventriculostomy is unknown. The objective of this study was to assess the safety of heparin immediately (within 4 h) after ventriculostomy in subarachnoid hemorrhage (SAH) patients undergoing endovascular treatment. Patients and Methods: This is a retrospective cohort study of 46 patients with aneurysmal SAH secondary to aneurysm rupture who required ventriculostomy. Post-ventriculostomy imaging was carefully reviewed for tract hemorrhaging. Timing of heparinization was noted. Early heparinization was within 4 h after ventriculostomy, and intermediate heparinization was between 4 and 24 h after ventriculostomy. Results: Overall, the tract hemorrhage rate was 26.1% for the study cohort—mostly grade I tract hemorrhages—consistent with the existing literature. The tract hemorrhage rate in the early (<4 h) heparin group was a remarkable 58.8%. The hemorrhages were also notably larger in the early (<4 h) heparin group. Conclusion: Although heparin appears to be safe after 4 h, immediate heparinization (within 4 h) after ventriculostomy significantly increases the odds of tract hemorrhage. Additional time should be afforded between ventriculostomy and heparinization to avoid potentially devastating external ventricular drain tract hemorrhage. It is advisable to wait a sufficient time (at least 4 h) after ventriculostomy before embarking on endovascular treatment of ruptured aneurysms.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 350-355 |
| Number of pages | 6 |
| Journal | Neurocritical Care |
| Volume | 27 |
| Issue number | 3 |
| DOIs | |
| State | Published - Dec 1 2017 |
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Keywords
- External ventricular drain
- Hemorrhage
- Heparin
- Subarachnoid hemorrhage
- Ventriculostomy
ASJC Scopus subject areas
- Clinical Neurology
- Critical Care and Intensive Care Medicine
Cite this
Hemorrhage Rate After External Ventricular Drain Placement in Subarachnoid Hemorrhage : Time to Heparin Administration. / Gard, Andrew P.; Sayles, Brian D.; Robbins, J. Will; Thorell, William E; Surdell, Daniel L.
In: Neurocritical Care, Vol. 27, No. 3, 01.12.2017, p. 350-355.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Hemorrhage Rate After External Ventricular Drain Placement in Subarachnoid Hemorrhage
T2 - Time to Heparin Administration
AU - Gard, Andrew P.
AU - Sayles, Brian D.
AU - Robbins, J. Will
AU - Thorell, William E
AU - Surdell, Daniel L
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Objective: The use of antiplatelet or anticoagulants has previously been shown to increase hemorrhagic complications of ventricular catheterization. Although heparin use 24 h after ventriculostomy appears safe, the safety of heparin immediately (within 4 h) after ventriculostomy is unknown. The objective of this study was to assess the safety of heparin immediately (within 4 h) after ventriculostomy in subarachnoid hemorrhage (SAH) patients undergoing endovascular treatment. Patients and Methods: This is a retrospective cohort study of 46 patients with aneurysmal SAH secondary to aneurysm rupture who required ventriculostomy. Post-ventriculostomy imaging was carefully reviewed for tract hemorrhaging. Timing of heparinization was noted. Early heparinization was within 4 h after ventriculostomy, and intermediate heparinization was between 4 and 24 h after ventriculostomy. Results: Overall, the tract hemorrhage rate was 26.1% for the study cohort—mostly grade I tract hemorrhages—consistent with the existing literature. The tract hemorrhage rate in the early (<4 h) heparin group was a remarkable 58.8%. The hemorrhages were also notably larger in the early (<4 h) heparin group. Conclusion: Although heparin appears to be safe after 4 h, immediate heparinization (within 4 h) after ventriculostomy significantly increases the odds of tract hemorrhage. Additional time should be afforded between ventriculostomy and heparinization to avoid potentially devastating external ventricular drain tract hemorrhage. It is advisable to wait a sufficient time (at least 4 h) after ventriculostomy before embarking on endovascular treatment of ruptured aneurysms.
AB - Objective: The use of antiplatelet or anticoagulants has previously been shown to increase hemorrhagic complications of ventricular catheterization. Although heparin use 24 h after ventriculostomy appears safe, the safety of heparin immediately (within 4 h) after ventriculostomy is unknown. The objective of this study was to assess the safety of heparin immediately (within 4 h) after ventriculostomy in subarachnoid hemorrhage (SAH) patients undergoing endovascular treatment. Patients and Methods: This is a retrospective cohort study of 46 patients with aneurysmal SAH secondary to aneurysm rupture who required ventriculostomy. Post-ventriculostomy imaging was carefully reviewed for tract hemorrhaging. Timing of heparinization was noted. Early heparinization was within 4 h after ventriculostomy, and intermediate heparinization was between 4 and 24 h after ventriculostomy. Results: Overall, the tract hemorrhage rate was 26.1% for the study cohort—mostly grade I tract hemorrhages—consistent with the existing literature. The tract hemorrhage rate in the early (<4 h) heparin group was a remarkable 58.8%. The hemorrhages were also notably larger in the early (<4 h) heparin group. Conclusion: Although heparin appears to be safe after 4 h, immediate heparinization (within 4 h) after ventriculostomy significantly increases the odds of tract hemorrhage. Additional time should be afforded between ventriculostomy and heparinization to avoid potentially devastating external ventricular drain tract hemorrhage. It is advisable to wait a sufficient time (at least 4 h) after ventriculostomy before embarking on endovascular treatment of ruptured aneurysms.
KW - External ventricular drain
KW - Hemorrhage
KW - Heparin
KW - Subarachnoid hemorrhage
KW - Ventriculostomy
UR - http://www.scopus.com/inward/record.url?scp=85020716402&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85020716402&partnerID=8YFLogxK
U2 - 10.1007/s12028-017-0417-4
DO - 10.1007/s12028-017-0417-4
M3 - Article
C2 - 28612132
AN - SCOPUS:85020716402
VL - 27
SP - 350
EP - 355
JO - Neurocritical Care
JF - Neurocritical Care
SN - 1541-6933
IS - 3
ER -