Multidisciplinary Bundle Approach in Venous Thromboembolism Prophylaxis in Patients with Non-Traumatic Subarachnoid Hemorrhage

Abstract

Background: The incidence of asymptomatic deep vein thrombosis (DVT) is reported to be up to 21% in patients with non-traumatic subarachnoid hemorrhage (SAH). A venous thromboembolism (VTE) bundle was launched in 2016 at the University of Illinois Hospital (UIH) aiming to reduce the rate of newly diagnosed VTE in the neurosurgical ICU. Two main elements of the bundle included prospective and daily audit on the correct use of intermittent pneumatic compression (IPC) and compliance of subcutaneous heparin (SQH). Methods: Patients with SAH were retrospectively identified from April 2014 until July 2018 (two years before and after the bundle implementation). VTE events were diagnosed using twice weekly lower-extremity venous Duplex ultrasound and chest computerized tomography when appropriate. Results: A total of 266 patients were included, with 133 of them in the post-bundle group. The incidence of VTE was not significantly different before and after the bundle (15% vs. 12%, p = 0.47). Out of all intended interventions within the bundle, only the compliance rate of IPC was significantly higher in the post-bundle group. No difference was found regarding new episode of intracranial hemorrhage secondary to SQH (1.5% vs. 2.1%, p = 0.65). Multivariate analysis demonstrated that longer ICU LOS, higher Caprini score, and presence of baseline lung diseases were associated with VTE development. Conclusions: With a median Caprini score of 9, our patient population was found to be at high risk for developing VTE. The implementation of the VTE bundle did not significantly reduce the rate of VTE in patients with non-traumatic SAH at UIH. ORigiNAL ReSeARCh