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Hemorrhagic stroke
Original research
Outcomes of heparin-induced thrombocytopenia type II in aneurysmal subarachnoid hemorrhage patients: A US nationwide analysis
  1. Galadu Subah1,2,3,
  2. Sabrina Zeller1,
  3. Nitesh Damodara1,
  4. Michael Fortunato2,
  5. Jenna Garrett2,
  6. Shoaib Syed2,
  7. Anaz Uddin2,
  8. Issac Pak4,
  9. Eric Feldstein1,
  10. Stephan Mayer1,3,
  11. Chirag D Gandhi1,
  12. Fawaz Al-Mufti1,3
  1. 1Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
  2. 2School of Medicine, New York Medical College, Valhalla, New York, USA
  3. 3Department of Neurology, New York Westchester Square Medical Center, Bronx, New York, USA
  4. 4Department of Nephrology, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
  1. Correspondence to Dr Fawaz Al-Mufti, Department of Neurosurgery, New York Westchester Square Medical Center, Bronx, New York, USA; fawaz.al-mufti{at}wmchealth.org

Abstract

Background Despite the widespread use of heparin during and following endovascular procedures in the management of aneurysmal subarachnoid hemorrhage (SAH) patients, limited research has explored the incidence and impact of heparin-induced thrombocytopenia (HIT) on SAH.

Methods Descriptive statistics, multivariate regressions, and propensity score-matching were employed to compare clinical characteristics, comorbidities, interventions, complications, and outcomes of HIT in SAH patients identified within the US National Inpatient Sample database from 2010 to 2019.

Results Among 76 387 SAH patients from 2010 to 2019, 166 (0.22%) developed HIT. HIT was identified as a significant predictor of prolonged length of stay (OR 6.799, 95% CI 3.985 to 11.6, P<0.01) and poor functional outcomes (OR 2.541, 95% CI 1.628 to 3.966, P<0.01) after adjusting for relevant factors. HIT incidence was higher in patients with elevated SAH severity scores (1.42 vs 1.06, P<0.01), younger patients (58.04 vs 61.39 years, P=0.01), overweight individuals (0.4% vs 0.2%, P<0.01), those on long-term anticoagulants (10.84% vs 5.72%, P<0.01), or with a cerebrospinal fluid drainage device (external ventricular drain, ventriculoperitoneal shunt; P<0.01). HIT patients showed increased rates of endovascular coiling, ventricular drain placement, shunt placement, deep vein thrombosis, urinary tract infection, acute kidney injury, pulmonary embolism, venous sinus thrombosis, pneumonia, and cerebral vasospasm (all P<0.01).

Conclusion SAH patients with HIT exhibited various comorbidities and increased rates of complications, which may contribute to extended hospital stays. This nationwide study aids clinical suspicion and highlights HIT’s impact on SAH patients.

  • aneurysm
  • complication
  • hemorrhage
  • subarachnoid

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-021438

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @shoaibsyed123, @almuftifawaz

    • Contributors Conceptualization was completed by GS, SZ, and FA-M. Methodology was designed by GS, SZ, ND, and FA-M. Validation was performed by GS, SZ, IP, and FA-M. Formal analysis was performed by GS, AU, and FA-M. Investigation was completed by GS, SZ, EF, and FA-M. Resources was provided by SM, CDG, and FA-M. Data curation was accomplished by GS, AU, and FA-M. Writing of the original draft was executed by GS, SZ, MF, SS, and FA-M. Review and editing were performed by GS, SZ, ND, MF, and FA-M. Visualization was executed by GS, JG, and FA-M. Supervision was provided by SM, CG, and FA-M. Project administration was provided by SM, CDG, and FA-M. FA-M accepts full responsibility for the overall content of this manuscript as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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