Venous thromboembolism in subarachnoid hemorrhage

Venous thrombembolism is a significant cause of mortality in patients after subarachnoid hemorrhage (SAH). After screening a cohort of SAH for this complication, we proposed a refinement for risk stratification of venous thromboembolism.

Our retrospective study included patients admitted to our academic medical center (2005-2007) for SAH from ruptured aneurysm and having survived beyond 72 hours. The 196 patients then underwent screening (i.e., duplex scans of the lower extremities) for deep vein thrombosis (DVT). Ultrasound scans were obtained when there was a clinical suspicion of DVT. Patient demographics and clinical variables were assessed as risk factors for DVT by logistic regression analysis.

Among 196 patients, the incidence of DVT was 9.7% and pulmonary embolism was 2%. In univariate analysis, factors significantly associated with DVT were absence of tobacco smoking, black race, male gender, poor admission Glasgow Coma Scale or World Federation of Neurological Surgeons grading scale for SAH, tall height, long hospital stay, and heavier body weight (P< 0.05). In multivariate analysis, only smoking, race, and length of stay were significant independent predictors of DVT. Aneurysm securing method and hypertension had no association with DVT.

Finding our SAH patients to be the largest group screened for DVT on the basis of our literature review, we confirmed many known risk factors for DVT and observed that smokers who abruptly quit lowered their risk of DVT. Our findings may be used for risk stratification when determining DVT chemoprophylaxis after SAH.