Deep Venous Thrombosis Prophylaxis

Although clinicians are generally advised to use prophylactic therapy to reduce the risk for developing deep venous thrombosis in patients after repair of ruptured aneurysms, limited data are available to guide specific therapeutic decisions. An electronic literature search was conducted to identify English-language articles that addressed prophylactic treatment for deep venous thrombosis after subarachnoid hemorrhage published between 1980 and March 2011. A total of 12 articles were included in this review, including seven original research studies and one meta-analysis. The incidence of deep venous thrombosis varied among studies, with the highest incidence reported with prospective ultrasound screening. Poor-grade patients are at highest risk. Mechanical prophylactic methods appear to be modestly effective as monotherapy, without significant risk for the typical patient with subarachnoid hemorrhage. Unfractionated heparin is moderately effective but carries a small risk of intracranial hemorrhage. Low molecular weight heparin has been linked to an increased risk for intracranial hemorrhage. Limited data are available to direct the timing and duration of prophylactic therapies.