A non-randomized study of safety and efficacy of heparin for DVT prophylaxis in intracerebral haemorrhage

Mohammad Wasay, Aga Khan University
Saqibuddin Khan, Abbasi Shaheed Hospital
Khawaja S Zaki, Aga Khan University
Bhojo A Khealani, Aga Khan University
Ayeesha Kamal, Aga Khan University
Iqbal Azam, Aga Khan University
Ismail A Khatri, Shifa International Hospitals


To evaluate the safety and efficacy of subcutaneous heparin for deep venous thrombosis (DVT) prophylaxis in patients with intracerebral haemorrhage (ICH) during acute phase in comparison to elastic stockings. The diagnosis of ICH was based on imaging (CT or MRI) and DVT was based on Doppler ultrasound. A total of 458 patients were identified over a period of 5 years (1997-2001). Median age was 59 years (range:12-99 years). Two hundred (44%) patients received heparin (heparin group) in addition to elastic stockings and 258 (56%) patients were only given elastic stockings (stockings group). These two groups were not randomized. Heparin was administered subcutaneously (SQ) in doses of 2500-5000 international units twice daily. Two groups were matched for age (p = 0.5), sex (p = 0.28), presence of diabetes mellitus (p = 0.14), cigarette smoking (p = 0.045) and presence of hydrocephalus or midline shift on CT/MRI (p= 0.87). One patient developed DVT in control group while none developed DVT in heparin group (p = 0.18). One patient had worsening of ICH on repeat CT scan in Heparin group. This worsening was non fatal. Systemic haemorrhagic complications (non fatal) were seen in 7 (14%) patients receiving heparin. Twenty five patients (12%) in heparin group and 52 (20%) in control group died (p = 0.02). Subcutaneous heparin in doses of 2500-5000 units twice daily during acute phase in patients with ICH may be safe for DVT prophylaxis. It was not superior to elastic stockings in a non-randomized comparison to prevent DVT.