Abstract Body: Background
Patients with intracerebral hemorrhage (ICH) are known to have a higher risk of venous thromboembolism (VTE) than patients with acute ischemic stroke, but the factors underlying this difference have not been clearly identified. We investigated common characteristics of patients admitted for ICH to both determine the frequency of VTE in the population and to identify risk factors for the development of VTE.
Methods
This study was a single center, retrospective review of consecutively admitted patients with ICH between January 2014 to May 2019 at an academic tertiary referral hospital. We calculated odds ratios (OR) and 95% confidence intervals (95%CI) for development of VTE based off demographics and clinical characteristics. Risk factors with significant OR were then analyzed by multivariate logistic regression.
Results
The final cohort included 465 patients with ICH, with 58 developing in-hospital thromboembolic events (12.5%). Time to start of chemoprophylaxis overall was 5.12 days (±4.56), for patients who developed VTE the time to chemoprophylaxis was 10.09 days (±7.55), and for those without VTE 4.18 days (±2.93). Delayed initiation of chemoprophylaxis reached statistical significance (p<0.0001) in patients who ultimately developed VTE.
There were several factors that were significantly associated with presence of VTE: black race OR 2.87 (95% CI: 1.530-5.939, p=0.0027), presence of intraventricular hemorrhage OR 2.20 (95% CI: 1.240-3.91, p=0.0071), placement of extraventricular drain OR 6.12 (95% CI: 3.2-11.73, p=<0.0001), craniotomy OR 4.635 (95% CI: 1.952-11.007, p=0.0005), and ICH score ≥2 OR 4.346 (95% CI: 1.784-10.587, p=0.002).
Factors which were not clearly associated with presence of VTE included gender, age, ICH location (deep or lobar), recurrent ICH, ICH etiology, procedures other than extraventricular drain and craniotomy, and whether patients were on anticoagulation or antiplatelet agents prior admission.
Conclusions
Increased incidence of thrombosis was clearly associated with several factors including race, presence of intraventricular hemorrhage, ICH score of 2 or 3, intervention with EVD or craniotomy, and delay to initiation of chemoprophylaxis.