Prevention and Treatment of Venous Thromboembolism in Patients with Acute Intracerebral Hemorrhage

Deep venous thrombosis and pulmonary emboli are common preventable causes of morbidity and mortality in patients with acute intracerebral hemorrhage (ICH). The frequency of venous thromboembolism (VTE) in patients with acute ICH ranges from 0.5 to 13% in scant reports. The dilemma in the prevention and treatment of these complications is to reduce the morbidity of VTE without increasing the risk of intracranial rebleeding. There is a paucity of information about this issue, and the applicability of the recommendations for patients with ischemic stroke to those with ICH is unclear. From the available literature, the recommendations for prevention of VTE in patients with ICH are early mobilization, adequate hydration, pneumatic compression stockings, and (in stable patients) low-dose subcutaneous heparins. Considering the treatment of VTE in patients with ICH, placement of an inferior vena caval filter is the most frequent expert recommendation. While existing data are sparse and not sufficient to recommend modifications to current options, the way is open for randomized trials to test early use of antithrombotic agents for VTE in acute ICH patients.