Purpose Pipeline embolization devices (PEDs) are associated with inherent thrombotic complications as well as potentially catastrophic spontaneous intraparenchymal hemorrhage. Anti-platelet and anticoagulation therapy must be optimized to reduce thrombotic complications without increasing the incidence of hemorrhage. Post-procedural low dose heparin drip is a prophylactic measure to reduce ischemic stroke risk, with no published data to date reporting efficacy and complications. Here we report the thrombotic and hemorrhagic complication rates of patients receiving post-operative low dose heparin drip, and we compare our results to the published literature rates of patients not receiving such prophylaxis.
Materials and methods We completed a retrospective review of patients who had intracranial aneurysms treated with the Pipeline Embolization Device at Westchester Medical Center. A total of 73 individuals received post-operative low dose heparin for an average of 18 hours. Thrombotic and hemorrhagic complications were identified and reported. These rates were compared to the published literature rates of individuals not receiving post-operative heparin. Additional variables included PTT range, type of heparin protocol used (weight based vs physician controlled), total time of heparinization, heparin dose, and number of PEDs deployed.
Results 0% (0/73) patients developed thrombotic complications in the post-operative period. The reported literature rate of symptomatic thrombotic events is 6.6%. Post-operative heparin reduced symptomatic thrombotic complications following PED placement (p=0.0125). 2.7% (2/73) patients developed intraparenchymal hemorrhage resulting in neurological deficit, compared to a published rate of hemorrhagic complications approximating 3%.
Conclusions Post-procedural low dose heparin prophylaxis reduces thrombotic complications in the post-operative period, without increasing hemorrhagic complications.
Disclosures I. Rybkin: None. J. Cooper: None. G. Kaur: None. F. Al-Mufti: None. C. Gandhi: None. J. Santarelli: None.
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