Association between external ventricular drain removal or replacement and prophylactic anticoagulation in patients with aneurysmal subarachnoid hemorrhage: a propensity-adjusted analysis

Authors

Joshua S. Catapano, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Stefan W. Koester, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Parth P. Parikh, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Kavelin Rumalla, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Henry O. Stonnington, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Rohin Singh, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Ethan A. Winkler, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Christopher S. Graffeo, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Robert F. Rudy, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Visish M. Srinivasan, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Ruchira M. Jha, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Ashutosh P. Jadhav, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Felipe C. Albuquerque, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Michael T. Lawton, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Andrew F. Ducruet, Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA. Neuropub@barrowneuro.org.Follow

Document Type

Article

Abstract

BACKGROUND: Withholding prophylactic anticoagulation from patients with aneurysmal subarachnoid hemorrhage (aSAH) before external ventricular drain (EVD) removal or replacement remains controversial. This study analyzed whether prophylactic anticoagulation was associated with hemorrhagic complications related to EVD removal. METHOD: All aSAH patients treated from January 1, 2014, to July 31, 2019, with an EVD placed were retrospectively analyzed. Patients were compared based on the number of prophylactic anticoagulant doses withheld for EVD removal (> 1 vs. ≤ 1). The primary outcome analyzed was deep venous thrombosis (DVT) or pulmonary embolism (PE) after EVD removal. A propensity-adjusted logistic-regression analysis was performed for confounding variables. RESULTS: A total of 271 patients were analyzed. For EVD removal, > 1 dose was withheld from 116 (42.8%) patients. Six (2.2%) patients had a hemorrhage associated with EVD removal, and 17 (6.3%) patients had a DVT or PE. No significant difference in EVD-related hemorrhage after EVD removal was found between patients with  > 1 versus ≤ 1 dose of anticoagulant withheld (4 of 116 [3.5%] vs. 2 of 155 [1.3%]; p = 0.41) or between those with no doses withheld compared to ≥ 1 dose withheld (1 of 100 [1.0%] vs. 5 of 171 [2.9%]; p = 0.32). After adjustment, withholding > 1 dose of anticoagulant versus ≤ 1 dose was associated with the occurrence of DVT or PE (OR 4.8; 95% CI, 1.5-15.7; p = 0.009). CONCLUSIONS: In aSAH patients with EVDs, withholding > 1 dose of prophylactic anticoagulant for EVD removal was associated with an increased risk of DVT or PE and no reduction in catheter removal-associated hemorrhage.

Keywords

Aneurysmal subarachnoid hemorrhage, EVD, Prophylactic anticoagulation, aSAH

Medical Subject Headings

Humans; Subarachnoid Hemorrhage (complications, surgery); Retrospective Studies; Anticoagulants (adverse effects); Drainage (adverse effects); Ventriculostomy (adverse effects); Pulmonary Embolism

Publication Date

7-1-2023

Publication Title

Acta neurochirurgica

E-ISSN

0942-0940

Volume

165

Issue

7

First Page

1841

Last Page

1846

PubMed ID

37301800

Digital Object Identifier (DOI)

10.1007/s00701-023-05651-1

Recommended Citation

Catapano, Joshua S.; Koester, Stefan W.; Parikh, Parth P.; Rumalla, Kavelin; Stonnington, Henry O.; Singh, Rohin; Winkler, Ethan A.; Graffeo, Christopher S.; Rudy, Robert F.; Srinivasan, Visish M.; Jha, Ruchira M.; Jadhav, Ashutosh P.; Albuquerque, Felipe C.; Lawton, Michael T.; and Ducruet, Andrew F., "Association between external ventricular drain removal or replacement and prophylactic anticoagulation in patients with aneurysmal subarachnoid hemorrhage: a propensity-adjusted analysis" (2023). Translational Neuroscience. 2363.
https://scholar.barrowneuro.org/neurobiology/2363