Venous thromboembolic complications in patients with subarachnoid hemorrhage following cerebral aneurysm rupture

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OBJECTIVE

To analyze the incidence of in-hospital venous thromboembolic complications (VTEC) in patients with ruptured brain aneurysms followed by non-traumatic subarachnoid hemorrhage (SAH) and to evaluate the outcomes of anticoagulation for prevention and treatment of VTEC.

MATERIAL AND METHODS

A single-center cohort retrospective study enrolled 36 patients with non-traumatic SAH following cerebral aneurysm rupture. We analyzed diagnosis, prevention and treatment of VTEC between January 2020 and March 2022. Drug prevention of VTEC was carried out by low molecular weight heparins (LMWH). LMWH were prescribed depending on severity of hemorrhage, blood clotting test data and indications for surgery. Anticoagulants were prescribed as early as possible after intracranial hemorrhage (within 24 hours) or surgery (within 1—2 days). In case of venous thrombosis, we prescribed LMWH in therapeutic dosages.

RESULTS

Seven (19%) patients had venous thrombosis at admission. Therapeutic doses of LMWH were prescribed in 6 patients. One patient required implantation of cava filter in 2 days after embolization of cerebral aneurysm due to bilateral severe pulmonary embolism (PE). Mortality in these patients was 71.4%. Twenty-three (64%) patients received preventive anticoagulation. Of these, deep vein thrombosis developed in 13 (57%) patients, moderate pulmonary embolism — in 2 patients. In this group, 9 (39%) patients died. There were no major hemorrhagic complications associated with anticoagulation.

CONCLUSION

Incidence of VTEC is high in patients with non-traumatic SAH that requires target searching for venous thrombosis and preventive LMWH therapy.

Keywords:

subarachnoid hemorrhage

venous thrombosis

pulmonary embolism

Authors:

Khripun A.I.

Pirogov Russian National Research Medical University

ORCID: 0000-0001-7669-0835

Pryamikov A.D.

Pirogov Russian National Research Medical University;
Buyanov Moscow City Clinical Hospital

ORCID: 0000-0002-4202-7549

Mironkov A.B.

Pirogov Russian National Research Medical University;
Buyanov Moscow City Clinical Hospital

ORCID: 0000-0003-0951-908X

Asratyan S.A.

Buyanov City Clinical Hospital

Suryakhin V.S.

Buyanov City Clinical Hospital

Alimov A.N.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-1919-6504

Belkov M.V.

Buyanov Moscow City Clinical Hospital

Received:

30.05.2022

Accepted:

21.09.2022

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