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The three phases of vasospasm

J P Kapp, W R Neill, C L Neill

    Surgical Neurology
    |July 1, 1982
    PubMed
    Summary

    Systemic heparin may prevent prolonged cerebral vasospasm and ischemia after subarachnoid hemorrhage. In a study, heparin reduced ischemic complications from 23% to 6% and mortality from 16% to 10% in patients undergoing carotid ligation.

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    Area of Science:

    • Neurology
    • Vascular Surgery
    • Hematology

    Background:

    • Prolonged cerebral vasospasm following subarachnoid hemorrhage is a significant cause of secondary brain injury.
    • The pathophysiology involves arterial wall contraction, endothelial injury with platelet adherence, and proliferative endarteropathy.
    • Platelet aggregation may continuously supply spasmogenic factors, perpetuating vasospasm.

    Purpose of the Study:

    • To investigate the efficacy of systemic heparin in mitigating prolonged cerebral vasospasm and associated ischemic complications.
    • To test the hypothesis that heparin can interrupt the proposed platelet-driven cycle of vasospasm.

    Main Methods:

    • A retrospective comparison of 112 patients receiving systemic heparin with carotid ligation versus historical controls from the Cooperative Study (no heparin).
    • Analysis of ischemic complication rates, mortality, and recurrent subarachnoid hemorrhage incidence.

    Main Results:

    • Patients receiving heparin showed a significantly lower incidence of ischemic complications (6% vs. 23%).
    • Mortality decreased from 16% to 10% in the heparin group.
    • A slight reduction in recurrent subarachnoid hemorrhage was observed with heparin use.

    Conclusions:

    • The findings support the hypothesis that heparin can interrupt the mechanism of prolonged cerebral vasospasm.
    • Systemic heparin appears to be a safe and effective adjunct in patients with aneurysms protected by partial carotid ligation.
    • Heparin may reduce ischemic events and mortality in the context of subarachnoid hemorrhage management.

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