Abstract Details

Title Between Scylla and Charybdis: Risks of Early Therapeutic Anticoagulation for Venous Thromboembolism After Acute Intracranial Hemorrhage

Topic Neurocritical Care

Presentation(s) S21 - Neurocritical Care (2:48 PM-3:00 PM)

Poster/Presentation
Number 010

Background Venous thromboembolism is a common complication for patients in Neurointensive Care Units. The current AHA/ASA guidelines recommend waiting at least 4 weeks before starting anticoagulation in ICH patients. The decision to initiate tAC within 4 weeks of acute ICH is a continuing clinical dilemma for vascular neurologists and intensivists, with limited data to inform their judgment.

Objective

To assess the risk of hematoma expansion (HE) in patients with acute intracranial hemorrhage (ICH) requiring therapeutic anticoagulation (tAC) for the treatment of venous thromboembolism (VTE).

Design/Methods

A retrospective analysis of all adult patients (2014-2019) who received tAC for VTE within 4 weeks after acute ICH. Traumatic and spontaneous ICH were included. The main outcome was HE, either radiographically proven, or clinical deterioration necessitating cessation of tAC, or death due to HE.

Results

Fifty patients met inclusion criteria (mean age: 54 years, 80% male, 76% Caucasian). Median time from ICH to tAC initiation was 9.5 days (IQR 4-17), 40% received tAC < 7 days from ICH. Six patients (12%) met our primary outcome and developed HE, of whom two died. Patients with HE were more likely to present with hydrocephalus (67% vs. 16%, p=0.02). While not statistically significant, patients with HE were older (57.8 vs. 53.5 years), anticoagulated sooner (4 vs. 10 days), presented with lower GCS (50% vs. 39%, GCS < 8), had higher hematoma volume (50% vs. 42%, > 30cc), larger SDH diameter (16 mm vs. 8.35 mm).

Conclusions Our study is among the first to explore characteristics associated with HE in patients undergoing tAC with acute ICH. Most patients experienced an uncomplicated treatment course, but a small subset suffered expansion of ICH and mortality. Larger studies in different ICH subtypes are needed to identify determinants of HE in this high-acuity patient population.

Authors/Disclosures
Thuhien Nguyen, MD (University of Washington Medical Center) PRESENTER	An immediate family member of Dr. Nguyen has received personal compensation for serving as an employee of Caption Health. An immediate family member of Dr. Nguyen has stock in Caption Health. An immediate family member of Dr. Nguyen has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Charles P. Crooks II, MD (University of Washington Medical Center, Neurology)	Dr. Crooks has nothing to disclose.
	No disclosure on file
	No disclosure on file
Claire Creutzfeldt, MD	The institution of Dr. Creutzfeldt has received research support from NINDS. The institution of Dr. Creutzfeldt has received research support from NINR.
Sarah Wahlster, MD	Dr. Wahlster has nothing to disclose.