OBJECTIVE Of the complications that can occur during endovascular surgery in aneurysmal subarachnoid hemorrhage (aSAH) patients, thromboembolism remains a particular challenge for many surgeons. Heparin has been widely used for its prevention, but it has not been able to eliminate concerns about bleeding. Therefore, in this study, we tried to determine the risk of rebleeding associated with heparin use. METHODS We retrospectively analyzed the medical and surgical records of 109 patients that underwent endovascular embolization for a ruptured cerebral aneurysm at a single institution from 2010 to 2014. These patients were divided into two groups according to whether heparin was loaded or not, to determine the effect of heparin on rebleeding and to identify other risk factors of rebleeding. RESULTS This series included 40 men (36.7 %) and 69 women (63.3 %) of mean age 57.9 ± 14.8 years. In 80 patients (73.4 %), endovascular embolization was conducted using an intraoperative bolus of 5000 units of heparin, whereas in the other 29 (26.6 %) endovascular embolization was performed without an intraoperative heparin bolus. After procedures, 16 patients (14.7 %) experienced rebleeding and 2 (1.8 %) a thromboembolic event. Intraoperative heparin loading (OR 0.683 [95 % CI 0.199-2.338]) was not found to be related to postoperative rebleeding. Rather, logistic regression analysis showed preoperative modified Fisher grade (OR 2.037 [95 % CI 1.077-3.853]) and external ventricular drainage (OR 5.389 [95 % CI 1.171-24.801]) independently predicted rebleeding. CONCLUSIONS Heparin loading during endovascular treatment of ruptured cerebral aneurysms did not affect rebleeding. We conclude heparin loading to prevent thromboembolism during endovascular treatment may be considered a good option in aSAH patients.

中文翻译：

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动脉瘤性蛛网膜下腔出血患者血管内栓塞术中肝素负荷的安全性

目的 在动脉瘤性蛛网膜下腔出血 (aSAH) 患者血管内手术期间可能发生的并发症中，血栓栓塞仍然是许多外科医生面临的特殊挑战。肝素已被广泛用于预防，但仍无法消除对出血的担忧。因此，在本研究中，我们试图确定与使用肝素相关的再出血风险。方法回顾性分析2010-2014年在同一机构接受血管内栓塞治疗脑动脉瘤破裂患者的109例病历和手术记录，根据是否加载肝素将这些患者分为两组，以确定疗效肝素对再出血的影响并确定再出血的其他危险因素。结果 该系列包括 40 名男性 (36. 7 %) 和 69 名女性 (63.3 %)，平均年龄为 57.9 ± 14.8 岁。在 80 名患者 (73.4 %) 中，使用 5000 单位肝素的术中推注进行了血管内栓塞术，而在其他 29 名 (26.6 %) 患者中，在没有术中推注肝素的情况下进行了血管内栓塞术。手术后，16 名患者 (14.7%) 出现再出血和 2 名 (1.8%) 血栓栓塞事件。未发现术中肝素负荷（OR 0.683 [95 % CI 0.199-2.338]）与术后再出血有关。相反，逻辑回归分析显示术前修正 Fisher 等级（OR 2.037 [95 % CI 1.077-3.853]）和心室外引流（OR 5.389 [95 % CI 1.171-24.801]）独立预测再出血。结论 破裂脑动脉瘤血管内治疗期间肝素负荷不影响再出血。