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Ultra Early prophylaxis intervention in Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Friday, May 3, 2024

    Presenting Author(s)

  • Marcio Yuri Ferreira, MD

    Research Collaborator
    Program in Global Surgery and Social Change - Harvard Medical School. Postgraduate Program in Translational Surgery of Federal University of São Paulo, Brazil

    • Co-Author(s)

  • Filipi Andreão

    Medical Student
    Federal University of Rio de Janeiro
    Rio de Janeiro, RJ, BR

  • Raphael Bertani, MD

    Neurosurgeon
    Department of Neurosurgery, University of São Paulo
    São Paulo, SP, BR

  • LS

    Luis gustavo biondi Soares, MD

    Fellowship
    Federal University of São paulo, United States

  • FC

    Feres Chaddad, MD, PhD

    Neurosurgeon
    Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo Departamento de Neurocirurgia, Hospital Beneficência Portuguesa de São Paulo, United States

  • Lucca B. Palavani

    Medical Student
    Max Planck University Center

  • FS

    Felipe Salvagni, MD

    Neurosurgeon
    Federal University of Sao Paulo
    Curitiva, PR, BR

  • RW

    Raphael Wuo-Silva, PhD

    Researcher
    Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, United States

Introduction: Spontaneous intracerebral hemorrhage (sICH) emerges as a critical concern, marked by its association with significant complications such as mortality, hematoma expansion, and venous thromboembolism (VTE). Addressing the timing dilemma in VTE prophylaxis becomes paramount in the face of these challenges. This systematic review and single-arm meta-analysis aimed to identify the safety of ultra-early prophylaxis of VTE based on hematoma expansion and mortality rates among sICH patients.

Methods: A search was conducted on Pubmed, Embase, Web of Science, and Cochrane databases for studies reporting ultra-early prophylaxis for VTE intervention ( < 24h) in patients with sICH. We consider eligible for inclusion: (1) studies reporting outcomes related to mortality and hematoma expansion, (2) studies reporting four or more patients, (3) studies reporting prophylaxis for VTE up to 24 hours. Odds ratios (OR) with 95% confidence intervals were calculated to assess the effects. Heterogeneity was evaluated using I² statistics. Statistical analysis was performed using RStudio.

Results: Our research encompassed data from three studies involving a total of 276 patients. The analysis of hematoma expansion, conducted on all 276 patients, revealed an OR 0.14 (95% CI 10% to 19%, I² 4%) in the random effects model. Additionally, the mortality analysis, based on 129 patients, indicated a total mortality OR of 0.13 (95% CI 7% to 18%, I² 0%).

Conclusion : The systematic review and meta-analysis investigated the efficacy and safety of ultra-early intervention for VTE prophylaxis in sICH patients. Our findings underscore the importance of timely interventions, specifically within the first 24 hours, to prevent hematoma expansion and improve survival rates in sICH patients. The study emphasizes the need for further research with larger sample sizes to refine our understanding of the ideal timing for VTE prophylaxis in this critical medical condition.