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Case series
Effect of heparin on secondary brain injury in patients with subarachnoid hemorrhage: an additional ‘H’ therapy in vasospasm treatment
  1. Markus Bruder1,
  2. Sae-Yeon Won1,
  3. Sepide Kashefiolasl1,
  4. Marlies Wagner2,
  5. Nina Brawanski1,
  6. Nazife Dinc1,
  7. Volker Seifert1,
  8. Juergen Konczalla1
  1. 1Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany
  2. 2Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany
  1. Correspondence to Dr Markus Bruder, Department of Neurosurgery, Goethe University, Frankfurt 60528, Germany; markus.bruder{at}


Objective Secondary brain injury leads to high morbidity and mortality rates in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, evidence-based treatment strategies are sparse. Since heparin has various effects on neuroinflammation, microthromboembolism and vasomotor function, our objective was to determine whether heparin can be used as a multitarget prophylactic agent to ameliorate morbidity in SAH.

Methods Between June 1999 and December 2014, 718 patients received endovascular treatment after rupture of an intracranial aneurysm at our institution; 197 of them were treated with continuous unfractionated heparin in therapeutic dosages after the endovascular procedure. We performed a matched pair analysis to evaluate the effect of heparin on cerebral vasospasm (CVS), cerebral infarction (CI), and outcome.

Results The rate of severe CVS was significantly reduced in the heparin group compared with the control group (14.2% vs 25.4%; p=0.005). CI and multiple ischemic lesions were less often present in patients with heparin treatment. These effects were enhanced if patients were treated with heparin for >48 hours, but the difference was not significant. Favorable outcome at 6-month follow-up was achieved in 69% in the heparin group and in 65% in the control group.

Conclusions Patients receiving unfractionated continuous heparin after endovascular aneurysm occlusion have a significant reduction in the rate of severe CVS, have CI less often, and tend to have a favorable outcome more often. Our findings support the potential beneficial effects of heparin as a multitarget therapy in patients with SAH, resulting in an additional ‘H’ therapy in vasospasm treatment.

  • Aneurysm
  • Coil
  • Drug
  • Hemorrhage
  • Subarachnoid

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  • MB and S-YW are joint first authors and contributed equally.

  • Contributors MB and S-YW made equal substantial contributions to the conception and design of the work and acquisition and analysis of data (shared first authors). SK, NB and ND made substantial contributions to acquisition of data. MW made substantial contributions to the analysis of data. VoS and JK made substantial contributions to the conception and design of the work. All authors revised the article critically for important intellectual content and gave their final approval of the version to be published. All authors agreed to be accountable for all aspects of the work ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from the Ethics Committee of the Hospital of the Goethe University Frankfurt.

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