Retrospective Study Supports that Pharmacologic Venous Thromboembolism Prophylaxis After Intracerebral Hemorrhage is Safe, Underused.

Background: Patients with spontaneous non-traumatic intracerebral hemorrhage (ICH) have a heightened risk for venous thrombosis (VTE). The Stroke 2022 Guidelines suggest initiating pharmacologic prophylaxis after hemorrhage stabilization, as measured on repeat imaging within the first 24 hours of admission. However, pharmacologic prophylaxis is underutilized and there remain concerns that initiation of pharmacologic prophylaxis could increase hemorrhage size. This study examines the safety of initiating pharmacologic prophylaxis after hemorrhage stabilization.

Methods: This was a retrospective study of patients discharged with nontraumatic spontaneous ICH. The study population was from Providence Medical Centers in Washington, Oregon, and California. Patients, 18 years or older, presenting to a hospital between January 2018 and December 2021 with a primary diagnosis at discharge of ICH were included.

Results: Among the 228 included, 65.4% (n = 149) received mechanical prophylaxis only and 34.6% (n = 79) received any pharmacologic prophylaxis (with or without mechanical prophylaxis). Of those patients who received any pharmacologic prophylaxis, 55.7% (44) were administered pharmacologic prophylaxis within 48 hours of stabilization. There were no significant differences in age, sex, medical history, hemorrhage type, severity, or mortality in-hospital or at 30 days.

Conclusion: There were no significant differences in VTE events and hemorrhage expansion for spontaneous ICH patients who had pharmacologic with or without mechanical prophylaxis or mechanical only, consistent with previous literature. For patients who received pharmacologic prophylaxis after stabilization, none had hemorrhage expansion; our data support the 2022 guidelines that it is safe to administer pharmacologic prophylaxis after hemorrhage stabilization.