Heparin infusions in aneurysmal subarachnoid hemorrhages: clinical considerations for use beyond anticoagulation

Patients who have experienced an aneurysmal subarachnoid hemorrhage (aSAH) may face a significant morbidity burden following the acute phase of their injury. Though commonly employed as an anticoagulant, heparin may have clinical utility related to its ability to mitigate the production of pro-inflammatory cytokines and chelate oxidized blood.

A comprehensive review of the literature was conducted on PubMed, MEDLINE, Scopus, Cumulative Index of Nursing and Allied Health Library and Web of Science with the assistance of a medical reference librarian from January 2018 to March 2022. Two pieces of literature were evaluated in this review, both of which sought to determine the either efficacy or safety of heparin infusions in patients following an aSAH. The small sample size and the heterogeneity of outcome data reported makes defining a role in therapy for heparin difficult; however, it may be reasonable to use lower weight-based doses and to target a lower aPTT goal when considering a heparin infusion in these patients.

Many options beyond heparin infusions exist in the armamentarium for clinicians when managing aSAH patients. Additional research is required to elucidate therapeutic drug monitoring targets and dosing protocols.