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Thromb Haemost 2023; 123(10): 966-975
DOI: 10.1055/a-2068-6464
Stroke, Systemic or Venous Thromboembolism

Anticoagulant Management and Outcomes in Nontraumatic Intracranial Hemorrhage Complicated by Venous Thromboembolism: A Retrospective Chart Review

Johnathon Gorman
1   Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, British Columbia, Canada
2   Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton Ontario, Canada
,
Matteo Candeloro
3   Department of Innovative Technologies in Medicine and Dentistry, “G. D'Annunzio” University, Chieti, Italy
,
Sam Schulman 
2   Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton Ontario, Canada
› Author Affiliations Funding The study was performed with internal funds. Dr. Gorman was supported by a Friedman Award for Scholars in Health from the University of British Columbia and by the Vancouver General Hospital Foundation. Dr. Candeloro received salary from University “G d'Annunzio” for his research fellowship.
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Abstract

Background There are limited data on anticoagulant management of acute venous thromboembolism (VTE) after spontaneous intracranial hemorrhage (ICH).

Methods We reviewed retrospectively all cases diagnosed with VTE during hospitalization for spontaneous ICH at our center during 15 years. Anticoagulation management outcomes were (1) timing after ICH of anticoagulant initiation for VTE treatment, (2) use of immediate therapeutic dosing or stepwise dose escalation, and (3) the proportion achieving therapeutic dose. Primary clinical effectiveness outcome was recurrent VTE. Primary safety outcome was expanding ICH.

Results We analyzed 103 cases with VTE after 11 days (median; interquartile range [IQR]: 7–22) from the diagnosis of ICH. Forty patients (39%) achieved therapeutic anticoagulation 21.5 days (median; IQR: 14–34 days) from the ICH. Of those, 14 (35%; 14% of total) received immediately therapeutic dose and 26 (65%; 25% of total) had stepwise escalation. Anticoagulation was more aggressive in patients with VTE >14 days after admission versus those with earlier VTE diagnosis. Twenty-two patients (21%) experienced recurrent/progressive VTE—less frequently among patients with treatment escalation within 7 days or with no escalation than with escalation >7 days from the VTE. There were 19 deaths 6 days (median; IQR: 3.5–15) after the index VTE, with significantly higher in-hospital mortality rate among patients without escalation in anticoagulation.

Conclusion Prompt therapeutic anticoagulation for acute VTE seems safe when occurring more than 14 days after spontaneous ICH. For VTE occurring earlier, it might also be safe with therapeutic anticoagulation, but stepwise dose escalation to therapeutic within a 7-day period might be preferable.

Keywords

anticoagulants - intracranial hemorrhage - venous thromboembolism - hospitalization - outcomes

Authors' Contribution

J.G. contributed to the design, data capture, analysis, and manuscript; M.C. contributed to analysis and revision of the manuscript; S.S. contributed to design, data capture, analysis, and manuscript.


Supplementary Material



Publication History

Received: 05 January 2023

Accepted: 30 March 2023

Accepted Manuscript online:
04 April 2023

Article published online:
02 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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