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  • Predictors for venous-thromboembolism in patients with Aneurysmal subarachnoid hemorrhage.

    Final Number:
    1039

    Authors:
    Dushyant Damania MBBS; Kristopher T. Kimmell MD; Nancy T-M Kung JD; George E Koch BA; Megan T Battin; Jason Liew; Babak S. Jahromi MD PhD FRCS(C)

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a potentially devastating neurosurgical emergency. Much of the morbidity and mortality associated with aSAH is due to medical complications and prolonged hospital stay. One particular complication associated with aSAH is venous thromboembolism (VTE). We sought to identify clinical factors that may predict VTE in aSAH patients.

    Methods: We retrospectively reviewed patients treated for aSAH at our institution between 12/2001 and 12/2013. Patient demographics, Hunt & Hess grade, treatment type, VTE prophylaxis used, complications during admission, and VTE rates were collected.

    Results: Of the 402 patients in our review, 70% were females and the median age was 54 years (IQR=45.8-63). 25 (6.2%) patients experienced VTE during admission. On univariate analysis, VTE was significantly associated with: length of stay (LOS) >14 days vs. = 14 days (12.8% vs. 0%,p=<0.0001), percutaneous gastrostomy (PEG)tube (20% vs. 3.06%,p=<0.0001), mechanical ventilation >96 hours (13.9% vs. 3.14%,p=<0.0001), cerebral edema (18.4% vs. 4.5%,p=0.0002), decubitus ulcer (36.4% vs. 5.4%,p=<0.0029), pneumonia (12.3% vs. 4.9%,p=0.02), peripherally inserted central catheter (PICC)(10.66% vs. 4.3%,p=0.02), Hunt and Hess grade (p=0.04) , blood transfusion (13.5% vs. 5.5%,p=0.053), enteral nutrition (11.4% vs. 2.6%,p=0.0003), hydrocephalus (11.7% vs. 4.12%,p=0.005), sepsis (20% vs. 5.3%,p=0.0032). On multivariate analysis (adjusting for Hunt and Hess): LOS >14 days vs. = 14 days, PEG tube, mechanical ventilation >96 hours, cerebral edema, decubitus ulcer and pneumonia remained the strongest predictors of VTE. Patients who received subcutaneous Heparin post-operatively had an unexpected trend towards VTE (9.4% vs. 4.6%,p=0.058). There were no differences in VTE rates among patients who received clipping or coiling.

    Conclusions: Knowledge of predictors of VTE in aSAH may aid in developing preventative strategies in this critically ill population.

    Patient Care: This study will help determine target population of aneurysmal subarachnoid hemorrhage patients prone to venous-thromboembolism.

    Learning Objectives: Predictors of venous-thromboembolism in aneurysmal subarachnoid hemorrhage can aid in preventing morbidity, mortality and decrease length of stay in the hospital.

    References:

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