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Safety of intravenous heparin administration after endovascular treatment for ruptured intracranial aneurysms
  1. A Z Vance1,
  2. M V Jayaraman1,2,
  3. G J Dubel1,
  4. C E Doberstein2,
  5. R A Haas1,2
  1. 1Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
  2. 2Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
  1. Correspondence to Dr M V Jayaraman, Department of Diagnostic Imaging, Brown University/Rhode Island Hospital, 593 Eddy Street, 3rd Floor, Main Building, Providence, RI 02903, USA; mjayaraman{at}lifespan.org

Abstract

Introduction Thromboembolic events are the primary complications encountered during endovascular treatment (EVT) of intracranial aneurysms. Intraprocedural heparinization is common during EVT but is less common post-procedure. The safety of heparinization following EVT is unknown, especially for ruptured aneurysms.

Materials and methods The records of 138 consecutive patients at our institution from 1 January 2000 to 30 June 2007 who were treated with EVT for 140 ruptured intracranial aneurysms were reviewed. All patients were treated with low dose intravenous heparin post-procedure for 24 h as per the departmental protocol. Cases of worsening hemorrhage requiring surgical evacuation were considered significant hemorrhages. Prior surgical exploration and external ventricular drain (EVD) placement were also noted.

Results There were two cases (1.4%) of significant worsening hemorrhage during post-procedure heparin administration. Among 13 patients who underwent craniotomy (for hematoma evacuation or attempted surgical clipping) prior to EVT, there was one (7.7%) case of significant hemorrhage. Among the 60 patients who underwent EVD placement prior to EVT, there was one (1.7%) case of significant hemorrhage.

Conclusion Administration of systemic heparinization may be safe during the first 24 h post-EVT of a ruptured intracranial aneurysm in patients without recent craniotomy. Further study in determining the benefit of this protocol in reducing post-embolization thromboembolic complications may be warranted.

  • Aneurysm

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Rhode Island Hospital IRB.

  • Contributors All authors contributed to the concept, data review and manuscript preparation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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