Abstract Details

Title Compliance with Early Use of Prophylactic Anticoagulation after Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 047

Objective

Background BACKGROUND: Patients with intracerebral hemorrhage (ICH) are at high risk for developing venous thromboembolism (VTE). Current guidelines recommend starting prophylactic anticoagulation as early as hospital day 2.

Design/Methods DESIGN/METHODS: We retrospectively reviewed our institutional stroke registry for patients admitted in 2010 with a diagnosis of ICH. We excluded patients who 1) comfort care only; 2) died within 2 days; and 3) were ambulatory by hospital day 2. We abstracted data on demographics, clinical severity, radiographic features, and mode of VTE prophylaxis [intermittent pneumatic compression, subcutaneous unfractionated heparin, and/or low molecular weight heparin (LMWH)]. We assessed the contraindications to early (by hospital day 2) prophylactic anticoagulation and clinical or radiographic predictors of non-compliance.

Results RESULTS: We identified 137 patients (mean age 60.7 years, 56.2% male; 48.9% black) with a median ICH volume of 6.64 (median ICH score 1); locations were deep (38%), lobar (38%), infratentorial (18.2%), and primary IVH (5.8%). Among 131 (93.6%) patients treated with prophylactic anticoagulation: 119 received heparin and 12 LMWH. In 99 patients, prophylactic anticoagulation was initiated by hospital day 2. Of the 38 patients who did not receive early prophylactic anticoagulation, 21 had contraindications (15 procedures and 6 intraventricular thrombolytic use) while 17 had no documented contraindication (non-compliant). Besides age > 80 (p=0.093), no clinical or radiographic feature was associated with non-compliance with early prophylactic anticoagulation.

Conclusions CONCLUSIONS: Despite implementation of guideline-based practice, 12% of our ICH patients did not receive early prophylactic anticoagulation despite a clear lack of contraindication. Continued quality improvement towards guideline-driven care may be enhanced by the use of checklists to overcome individual physician biases and preferences.

Authors/Disclosures
Thomas W. Hoang, MD PRESENTER	No disclosure on file
	No disclosure on file
Sayona John, MD, FAAN (Cook County Health)	Dr. John has nothing to disclose.
Rajeev Garg, MD, FAAN (Rush University Medical Center)	Dr. Garg has nothing to disclose.
Katharina M. Busl, MD, MS, FAAN (University of Florida)	Dr. Busl has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rissman Law. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Huffman Powell Baley. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University Science. Dr. Busl has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SCCM. Dr. Busl has a non-compensated relationship as a Board Member with Art in Medicine that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Assistant Editor with Neurocritical Care that is relevant to AAN interests or activities.
Richard E. Temes, MD (Northwell Health)	No disclosure on file
Thomas P. Bleck, MD, FAAN (Northwestern University Department of Neurology)	Dr. Bleck has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Bleck has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus Pharmaceuticals. Dr. Bleck has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for iECURE. Dr. Bleck has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acasti. Dr. Bleck has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Society of Critical Care Medicine. Dr. Bleck has received research support from NIH.
Shyam Prabhakaran, MD (University of Chicago)	Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.

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