Association between external ventricular drain removal or replacement and prophylactic anticoagulation in patients with aneurysmal subarachnoid hemorrhage: a propensity-adjusted analysis

被引：3

作者：

Catapano, Joshua S. ^{[1
]}

Koester, Stefan W. ^{[1
]}

Parikh, Parth P. ^{[1
]}

Rumalla, Kavelin ^{[1
]}

Stonnington, Henry O. ^{[1
]}

Singh, Rohin ^{[1
]}

Winkler, Ethan A. ^{[1
]}

Graffeo, Christopher S. ^{[1
]}

Rudy, Robert F. ^{[1
]}

Srinivasan, Visish M. ^{[1
]}

Jha, Ruchira M. ^{[1
]}

Jadhav, Ashutosh P. ^{[1
]}

Albuquerque, Felipe C. ^{[1
]}

Lawton, Michael T. ^{[1
]}

Ducruet, Andrew F. ^{[1
]}

机构：

[1] St Josephs Hosp, Barrow Neurol Inst, Dept Neurosurg, Neurosci Publicat, 350 W Thomas Rd, Phoenix, AZ 85013 USA

来源：

ACTA NEUROCHIRURGICA | 2023年 / 165卷 / 07期

关键词：

Aneurysmal subarachnoid hemorrhage; aSAH; EVD; Prophylactic anticoagulation; DEEP-VEIN THROMBOSIS; UNFRACTIONATED HEPARIN; VENOUS THROMBOEMBOLISM; SURVEILLANCE BIAS; RISK-FACTORS; COMPLICATIONS; METAANALYSIS; PLACEMENT; THERAPY; SAFETY;

D O I：

10.1007/s00701-023-05651-1

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BackgroundWithholdingprophylactic anticoagulation from patients with aneurysmal subarachnoid hemorrhage (aSAH) before external ventricular drain (EVD) removal or replacement remains controversial. This study analyzed whether prophylactic anticoagulation was associated with hemorrhagic complications related to EVD removal.MethodAll aSAH patients treated from January 1, 2014, to July 31, 2019, with an EVD placed were retrospectively analyzed. Patients were compared based on the number of prophylactic anticoagulant doses withheld for EVD removal (> 1 vs. <= 1). The primary outcome analyzed was deep venous thrombosis (DVT) or pulmonary embolism (PE) after EVD removal. A propensity-adjusted logistic-regression analysis was performed for confounding variables.ResultsA total of 271 patients were analyzed. For EVD removal, > 1 dose was withheld from 116 (42.8%) patients. Six (2.2%) patients had a hemorrhage associated with EVD removal, and 17 (6.3%) patients had a DVT or PE. No significant difference in EVD-related hemorrhage after EVD removal was found between patients with > 1 versus <= 1 dose of anticoagulant withheld (4 of 116 [3.5%] vs. 2 of 155 [1.3%]; p = 0.41) or between those with no doses withheld compared to >= 1 dose withheld (1 of 100 [1.0%] vs. 5 of 171 [2.9%]; p = 0.32). After adjustment, withholding > 1 dose of anticoagulant versus <= 1 dose was associated with the occurrence of DVT or PE (OR 4.8; 95% CI, 1.5-15.7; p = 0.009).ConclusionsIn aSAH patients with EVDs, withholding > 1 dose of prophylactic anticoagulant for EVD removal was associated with an increased risk of DVT or PE and no reduction in catheter removal-associated hemorrhage.

引用

页码：1841 / 1846

页数：6

共 20 条

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