低分子肝素预防脑出血后静脉血栓的安全性研究

Safety of low molecular weight heparin for the prevention of venous thromboembolism after primary intracerebral haemorrhage

目的探讨脑出血患者抗凝预防静脉血栓栓塞时颅内血肿体积变化及相关安全性。方法回顾性分析脑出血或脑出血合并脑室出血的患者,均在入院7 d内予以注射低分子肝素,并在用药7 d后复查头颅CT。计算患者低分子肝素治疗前后CT上的颅内血肿体积的变化,血肿体积的计算使用ABC/2法,脑室出血量的计算使用手绘出血区域方法。结果共入选64例,平均年龄65岁,美国国立卫生研究院卒中量表(NIHSS)评分中位值为10.6,基线时血肿体积平均为(24.3±22.3)ml,低分子肝素治疗前后CT检查上的颅内血肿体积变化为(-4.35±10.5)ml,仅有1例的血肿体积增大。经分析,自发性脑出血患者发病7 d内给予低分子肝素预防深静脉血栓并不导致颅内血肿的增大。结论在脑出血伴/不伴脑室出血的急性期,给予皮下注射低分子肝素预防静脉血栓栓塞不导致颅内血肿的增大。

Objective To observe the hematoma volume in patients with ICH before and after pharmacological deep venous thrombosis prophylaxis. Methods We identified patients from our hospital who presented with ICH only or ICH with intraventricular hemorrhage and received low molecular weight heparin subcutaneously within 7 days of admission and had a repeat CT scan performed after 7 days of starting venous thromboembolism prophylaxis. We calculated the change in hematoma volume from the admission and post-treatment CTs. Hematoma volume was calculated using the ABC/2 method and intraventricular hemorrhage volumes were calculated using the hand drawn regions of interest. Results We identified 64 patients with a mean age of 65 years and median National Institutes of Health Stroke Scale score 10.6. The mean baseline total hematoma volume was （24.3 ± 22.3 ） ml. There was an change in hematoma volume from preand post-treatment CT of （ - 4.35～10.5 ） ml. One patients developed hematoma growth, Repeat analysis＇of patients given pharmacological deep venous thrombosis prophylaxis within 7days after ICH found no increase in hematoma size. Conclusion Pharmacological deep venous thrombosis prophylaxis given subcutaneously in patients with ICH and/or intraventricular hemorrhage in the acute period is generally not associated with hematoma growth.