Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage

Luca Masotti; Mario Di Napoli; Daniel Agustin Godoy; Grazia Panigada; Stefano Spolveri; Gianni Lorenzini; Giancarlo Landini

doi:doi:10.11648/j.ijcems.20150102.13

Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage

Luca Masotti, Mario Di Napoli, Daniel Agustin Godoy, Grazia Panigada, Stefano Spolveri, Gianni Lorenzini, Giancarlo Landini

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 1, Issue 2)

Received: 7 June 2015 Accepted: 24 June 2015 Published: 25 June 2015

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Abstract

Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the most feared complication in patients suffering from spontaneous intracerebral hemorrhage (ICH). The balance between VTE risk and the risk of hematoma expansion and/or re-bleeding is the cornerstone of prophylaxis which is based on non-pharmacological and pharmacological strategies. In the latest years results of three randomized clinical trials on non-pharmacological prophylaxis in ischemic and hemorrhagic stroke have been published. Intermittent pneumatic compression has shown to be effective in ICH compared to placebo, whereas graduated compression stockings failed to show their superiority over placebo. Few and low quality studies reported on pharmacological prophylaxis in ICH. Overall, these studies showed that pharmacological prophylaxis could be safe, but whether it is more effective than other non-pharmacological methods remains unclear. A meta-analysis of four randomized controlled studies showed that pharmacological prophylaxis significantly reduces the rate of pulmonary embolism. Consequently, recommendations from Scientific Societies for VTE prevention in ICH are based on weak literature evidence. In the present article, the Authors provide a review on VTE prevention in ICH and propose a practical algorithm for clinical management of this topic.

Published in	International Journal of Clinical and Experimental Medical Sciences (Volume 1, Issue 2)
DOI	10.11648/j.ijcems.20150102.13
Page(s)	16-21
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2015. Published by Science Publishing Group

Keywords

Venous Thromboembolism, Prophylaxis, Intracerebral Hemorrhage

References

[1]	Masotti L, Godoy D, Di Napoli M, Rabinstein A, Paciaroni M, Ageno W. Pharmacological prophylaxis of venous thromboembolism during acute phase of spontaneous intracerebral hemorrhage: what do we know about risks and benefits? Clin Appl Thromb Hemost 2012; 18; 393-402.
[2]	Skaf E, Stein PD, Beemath A, Sanchez J, Bustamante MA, Olson RE. Venous thromboembolism in patients with ischemic and hemorrhagic stroke. Am J Cardiol 2005; 96: 1731-3.
[3]	Wijdicks EF, Scott JP. Pulmonary embolism associated with acute stroke. Mayo Clin Proc 1997; 72: 297–300.
[4]	Andrè C, de Freitas GR, Fukujima MM. Prevention of deep venous thrombosis and pulmonary embolism following stroke: a systematic review of published articles. Eur J Neurol 2007; 14: 21–32.
[5]	CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicenter randomized controlled trial. Lancet 2013; 382: 516–24.
[6]	Dennis M, Mordi N, Graham C, Sandercock P; CLOTS trials collaboration. The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials. J Thromb Haemost 2011; 9: 2193-200.
[7]	Kim KS, Brophy GM. Symptomatc venous thromboembolism: incidence and risk factors in patients with spontaneous or traumatic intracranial hemorrhage. Neurocrit Care 2009; 11: 28-33.
[8]	Masotti L, Landini GC, Panigada G. The practical management of bleedings during treatment with direct oral anticoagulants: the emergency reversal therapy. Ital J Med 2013; 7 (suppl 8): 48-58.
[9]	Masotti L, Di Napoli M, Godoy D et al. The practical management of intracerebral hemorrhage associated with oral anticoagulant therapy. Intern J Stroke 2011; 6: 228-40
[10]	Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet 2009; 373: 1632-44.
[11]	Kappelle LJ. Preventing deep vein thrombosis after stroke: strategies and recommendations. Curr Treat Opt Neurol 2011; 13: 629-635
[12]	He C, Von Segesser LK, Kappetein PA, Mestres CA, Smith JA, Choong CK. Acute pulmonary embolectomy. Eur J Cardiothorac Surg 2013; 43: 1087-95
[13]	Baglin TP, Brush J, Streiff M for British Committee for Standards in Hematology. Guidelines on use of vena cava filters. Br J Hematol 2006; 134: 590-595.
[14]	Wartenberg K, Mayer Sa. Reducing the risk of ICH enlargement. J Neurol Sci 2007; 261: 99-107.
[15]	Rodriguez-Luna D, Rubiera M, Ribo M et al. Ultra early hematoma growth predicts poor outcome after acute intracerebral hemorrhage. Neurology 2011; 77: 1599-604.
[16]	Anderson CS, Heeley E, Huang Y et al. INTERACT 2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 2013; 368: 2355-65
[17]	Caprini JA. Mechanical methods for thrombosis prophylaxis. Clin Appl Thromb Hemost 2010; 16: 668-673.
[18]	Masotti L, Di Napoli M, Lorenzini G et al. Non pharmacological prophylaxis of venous thromboembolism in acutely ill medical patients. Cardiology and Angiology: an International Journal 2014; 2: 1-14
[19]	Lacut K, Bressollette L, Le Gal G et al.; VICTORIAh (Venous Intermittent Compression and Thrombosis Occurrence Related to Intra-cerebral Acute hemorrhage) Investigators. Prevention of venous thrombosis in patients with acute intracerebral hemorrhage. Neurology. 2005; 65: 865–9.
[20]	CLOTS Trials Collaboration, Dennis M, Sandercock PA, Reid J, Graham C, Murray G, Venables G, Rudd A, Bowler G. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicenter, randomized controlled trial. Lancet. 2009; 373: 1958-65.
[21]	The CLOTS (Clots in Legs or Stockings after Stroke) Trial Collaboration. Thigh-Length Versus Below-Knee Stockings for Deep Venous Thrombosis Prophylaxis After Stroke. A Randomized Trial. Ann Intern Med 2010; 153: 553-62.
[22]	Imberti D, Ageno W, Dentali F, Donadini M, Manfredini R, Gallerani M. Retrievable vena cava filters: a clinical review. J Thromb Thrombolysis 2012; 33: 258-66.
[23]	Baron TH, Kamath PS, McBane RD. Management of antithrombotic therapy in patients undergoing invasive procedures. N Eng J Med 2013; 368: 2113-2124.
[24]	Liew NC, Chang YH, Choi G et al. Asian venous thromboembolism guidelines: prevention of venous thromboembolism. Int Angiol 2012; 31: 501-516
[25]	Swami U, Annunziata G, Fulger I. Experience With Vena Cava Filters at a Large Community Hospital and Level-I Trauma Center: Indications, Complications, and Compliance Barriers. Clin Appl Thromb Hemost 2013. In press
[26]	Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med 2007; 146: 278-88.
[27]	Prabhakaran S, Herbers P, Khoury J, Adeoye O, Khatri P, Ferioli S, Kleindorfer DO. Is prophylactic anticoagulation for deep venous thrombosis common practice after intracerebral hemorrhage? Stroke 2015; 46: 369-75.
[28]	Dickmann U, Voth E, Schicha H, Henze T, Prange H, Emrich D. Heparin therapy, deep-vein thrombosis and pulmonary embolism after intracerebral hemorrhage. Klin Wochenschr 1988; 66: 1182–3.
[29]	Boeer A, Voth E, Henze T, Prange HW. Early heparin therapy in patients with spontaneous intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 1991; 54: 466–7.
[30]	Kleindienst A, Harvey HB, Mater E, Bronst J, Flack J, Herenz K, Haupt WF, Scon R. Early antithrombotic prophylaxis with low molecular weight heparin in neurosurgery. Acta Neurochir (Wien), 2003; 145: 1085-91.
[31]	Harvey RL, Lovell LL, Belanger N, Roth EJ. The Effectiveness of Anticoagulant and Antiplatelet Agents in Preventing Venous Thromboembolism During Stroke Rehabilitation: A Historical Cohort Study. Arch Phys Med Rehabil 2004; 85:1070-5.
[32]	Tetri S, Hakala J, Juvela S, Saloheimo P, Pyhtinen J, Rusanen H, Savolainen ER, Hillbom M.. Safety of lowdose subcutaneous enoxaparin for the prevention of venous thromboembolism after primary intracerebral haemorrhage. Thromb Res 2008; 123: 206–12.
[33]	Wasay M, Khan S, Zaki KS, Khealani BA, Kamal A, Azam I, Khatri IA. A non-randomized study of safety and efficacy of heparin for DVT prophylaxis in intracerebral hemorrhage. J Pak Med Assoc 2008; 58: 362-4.
[34]	Orken DN, Kenangil G, Ozkurt H, Guner C, Gundogdu L, Basak M, Forta H. Prevention of deep venous thrombosis and pulmonary embolism in patients with acute intracerebral hemorrhage. Neurologist 2009; 15: 329-31.
[35]	Kiphuth IC, Staykov D, Köhrmann M et. Early Administration of Low Molecular Weight Heparin after Spontaneous Intracerebral Hemorrhage. Cerebrovasc Dis 2009; 27: 146-50.
[36]	Wu TC, Kasam M, Harun N et al. Pharmacological deep vein thrombosis prohylaxis does not lead to hematoma expansion in intracerebral hemorrhage with intraventricular extension. Stroke 2011; 42: 705-709.
[37]	Paciaroni M, Agnelli G, Venti M, Alberti A, Acciarresi M, Caso V. Efficacy and Safety of Anticoagulants in the prevention of venous thromboembolism in patients with acute cerebral hemorrhage. A Meta-Analysis of Controlled Studies. J Thromb Haemost 2011; 9: 893-8.
[38]	Qaseem A, Chou R, Humphrey LL, Starkey M, Shekelle P for the Clinical Guidelines Committee of the American College of Physicians. Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2011; 155: 625-32.
[39]	Lansberg MG, O'Donnell MJ, Khatri P et al. Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e601S-36S.
[40]	Liew NC, Chang YH, Choi G, et al. Asian venous thromboembolism guidelines: prevention of venous thromboembolism. Int Angiol 2012; 31: 501-516.
[41]	Nicolaides A, Fareed J, Kakkar AK et al. Prevention and Treatment of Venous Thromboembolism International Consensus Statement (Guidelines according to scientific evidence) Medical Patients. Clin Appl Thromb Haemost 2013; 19: 163-171.
[42]	Rodríguez-Yáñez M, Castellanos M, Freijo MM et al. Clinical practice guidelines in intracerebral haemorrhage. Neurologia 2013; 28: 236-49.
[43]	Steiner T, Al-Shahi Salman R, Beer R et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 2014; 9: 840-55.
[44]	Hemphill JC 3rd, Greenberg SM, Anderson CS et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015; Epub ahead of print.

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APA Style

Luca Masotti, Mario Di Napoli, Daniel Agustin Godoy, Grazia Panigada, Stefano Spolveri, et al. (2015). Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage. International Journal of Clinical and Experimental Medical Sciences, 1(2), 16-21. https://doi.org/10.11648/j.ijcems.20150102.13

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ACS Style

Luca Masotti; Mario Di Napoli; Daniel Agustin Godoy; Grazia Panigada; Stefano Spolveri, et al. Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage. Int. J. Clin. Exp. Med. Sci. 2015, 1(2), 16-21. doi: 10.11648/j.ijcems.20150102.13

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AMA Style

Luca Masotti, Mario Di Napoli, Daniel Agustin Godoy, Grazia Panigada, Stefano Spolveri, et al. Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage. Int J Clin Exp Med Sci. 2015;1(2):16-21. doi: 10.11648/j.ijcems.20150102.13

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@article{10.11648/j.ijcems.20150102.13,
  author = {Luca Masotti and Mario Di Napoli and Daniel Agustin Godoy and Grazia Panigada and Stefano Spolveri and Gianni Lorenzini and Giancarlo Landini},
  title = {Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {1},
  number = {2},
  pages = {16-21},
  doi = {10.11648/j.ijcems.20150102.13},
  url = {https://doi.org/10.11648/j.ijcems.20150102.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20150102.13},
  abstract = {Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the most feared complication in patients suffering from spontaneous intracerebral hemorrhage (ICH). The balance between VTE risk and the risk of hematoma expansion and/or re-bleeding is the cornerstone of prophylaxis which is based on non-pharmacological and pharmacological strategies. In the latest years results of three randomized clinical trials on non-pharmacological prophylaxis in ischemic and hemorrhagic stroke have been published. Intermittent pneumatic compression has shown to be effective in ICH compared to placebo, whereas graduated compression stockings failed to show their superiority over placebo. Few and low quality studies reported on pharmacological prophylaxis in ICH. Overall, these studies showed that pharmacological prophylaxis could be safe, but whether it is more effective than other non-pharmacological methods remains unclear. A meta-analysis of four randomized controlled studies showed that pharmacological prophylaxis significantly reduces the rate of pulmonary embolism. Consequently, recommendations from Scientific Societies for VTE prevention in ICH are based on weak literature evidence. In the present article, the Authors provide a review on VTE prevention in ICH and propose a practical algorithm for clinical management of this topic.},
 year = {2015}
}

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TY  - JOUR
T1  - Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage
AU  - Luca Masotti
AU  - Mario Di Napoli
AU  - Daniel Agustin Godoy
AU  - Grazia Panigada
AU  - Stefano Spolveri
AU  - Gianni Lorenzini
AU  - Giancarlo Landini
Y1  - 2015/06/25
PY  - 2015
N1  - https://doi.org/10.11648/j.ijcems.20150102.13
DO  - 10.11648/j.ijcems.20150102.13
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 16
EP  - 21
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20150102.13
AB  - Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the most feared complication in patients suffering from spontaneous intracerebral hemorrhage (ICH). The balance between VTE risk and the risk of hematoma expansion and/or re-bleeding is the cornerstone of prophylaxis which is based on non-pharmacological and pharmacological strategies. In the latest years results of three randomized clinical trials on non-pharmacological prophylaxis in ischemic and hemorrhagic stroke have been published. Intermittent pneumatic compression has shown to be effective in ICH compared to placebo, whereas graduated compression stockings failed to show their superiority over placebo. Few and low quality studies reported on pharmacological prophylaxis in ICH. Overall, these studies showed that pharmacological prophylaxis could be safe, but whether it is more effective than other non-pharmacological methods remains unclear. A meta-analysis of four randomized controlled studies showed that pharmacological prophylaxis significantly reduces the rate of pulmonary embolism. Consequently, recommendations from Scientific Societies for VTE prevention in ICH are based on weak literature evidence. In the present article, the Authors provide a review on VTE prevention in ICH and propose a practical algorithm for clinical management of this topic.
VL  - 1
IS  - 2
ER  -

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Author Information

Luca Masotti

Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy
Mario Di Napoli

Neurological Service, San Camillo de’ Lellis Hospital, Rieti, Italy
Daniel Agustin Godoy

Neurointensive Care Unit, Sanatorio Pasteur and Intensive Care Unit, Hospital San Juan Bautista, Catamarca, Argentina
Grazia Panigada

Internal Medicine, SS Damiano and Cosma Hospital, Pescia, Italy
Stefano Spolveri

Internal Medicine, Borgo San Lorenzo Hospital, Florence, Italy
Gianni Lorenzini

Emergency Medicine, Pontedera Hospital, Pisa, Italy
Giancarlo Landini

Internal Medicine, Borgo San Lorenzo Hospital, Florence, Italy

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APA Style

Luca Masotti, Mario Di Napoli, Daniel Agustin Godoy, Grazia Panigada, Stefano Spolveri, et al. (2015). Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage. International Journal of Clinical and Experimental Medical Sciences, 1(2), 16-21. https://doi.org/10.11648/j.ijcems.20150102.13

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ACS Style

Luca Masotti; Mario Di Napoli; Daniel Agustin Godoy; Grazia Panigada; Stefano Spolveri, et al. Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage. Int. J. Clin. Exp. Med. Sci. 2015, 1(2), 16-21. doi: 10.11648/j.ijcems.20150102.13

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AMA Style

Luca Masotti, Mario Di Napoli, Daniel Agustin Godoy, Grazia Panigada, Stefano Spolveri, et al. Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage. Int J Clin Exp Med Sci. 2015;1(2):16-21. doi: 10.11648/j.ijcems.20150102.13

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@article{10.11648/j.ijcems.20150102.13,
  author = {Luca Masotti and Mario Di Napoli and Daniel Agustin Godoy and Grazia Panigada and Stefano Spolveri and Gianni Lorenzini and Giancarlo Landini},
  title = {Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {1},
  number = {2},
  pages = {16-21},
  doi = {10.11648/j.ijcems.20150102.13},
  url = {https://doi.org/10.11648/j.ijcems.20150102.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20150102.13},
  abstract = {Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the most feared complication in patients suffering from spontaneous intracerebral hemorrhage (ICH). The balance between VTE risk and the risk of hematoma expansion and/or re-bleeding is the cornerstone of prophylaxis which is based on non-pharmacological and pharmacological strategies. In the latest years results of three randomized clinical trials on non-pharmacological prophylaxis in ischemic and hemorrhagic stroke have been published. Intermittent pneumatic compression has shown to be effective in ICH compared to placebo, whereas graduated compression stockings failed to show their superiority over placebo. Few and low quality studies reported on pharmacological prophylaxis in ICH. Overall, these studies showed that pharmacological prophylaxis could be safe, but whether it is more effective than other non-pharmacological methods remains unclear. A meta-analysis of four randomized controlled studies showed that pharmacological prophylaxis significantly reduces the rate of pulmonary embolism. Consequently, recommendations from Scientific Societies for VTE prevention in ICH are based on weak literature evidence. In the present article, the Authors provide a review on VTE prevention in ICH and propose a practical algorithm for clinical management of this topic.},
 year = {2015}
}

Copy | Download

TY  - JOUR
T1  - Venous Thromboembolism Prevention in Spontaneous Intracerebral Hemorrhage
AU  - Luca Masotti
AU  - Mario Di Napoli
AU  - Daniel Agustin Godoy
AU  - Grazia Panigada
AU  - Stefano Spolveri
AU  - Gianni Lorenzini
AU  - Giancarlo Landini
Y1  - 2015/06/25
PY  - 2015
N1  - https://doi.org/10.11648/j.ijcems.20150102.13
DO  - 10.11648/j.ijcems.20150102.13
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 16
EP  - 21
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20150102.13
AB  - Venous thromboembolism (VTE), encompassing for deep vein thrombosis (DVT) and pulmonary embolism (PE), represents the most feared complication in patients suffering from spontaneous intracerebral hemorrhage (ICH). The balance between VTE risk and the risk of hematoma expansion and/or re-bleeding is the cornerstone of prophylaxis which is based on non-pharmacological and pharmacological strategies. In the latest years results of three randomized clinical trials on non-pharmacological prophylaxis in ischemic and hemorrhagic stroke have been published. Intermittent pneumatic compression has shown to be effective in ICH compared to placebo, whereas graduated compression stockings failed to show their superiority over placebo. Few and low quality studies reported on pharmacological prophylaxis in ICH. Overall, these studies showed that pharmacological prophylaxis could be safe, but whether it is more effective than other non-pharmacological methods remains unclear. A meta-analysis of four randomized controlled studies showed that pharmacological prophylaxis significantly reduces the rate of pulmonary embolism. Consequently, recommendations from Scientific Societies for VTE prevention in ICH are based on weak literature evidence. In the present article, the Authors provide a review on VTE prevention in ICH and propose a practical algorithm for clinical management of this topic.
VL  - 1
IS  - 2
ER  -

Copy | Download