Abstract TMP18: Heparin Resistance is an Independent Predictor of Poor outcome in Cerebral Venous Sinus Thrombosis

• Published in: Stroke (1970) Vol. 49; no. Suppl_1
• Main Authors: Aksan, Nazan, Samaniego, Edgar, Shaban, Amir, Siddiqui, Fazeel, Dai, Biyue, Ahmed, Uzair, Granchi, Julia, Zheng-Lin, Binbin, Morcuende, Jorge, Adams, Harold, Leira, Enrique, Ortega-Gutierrez, Santiago
• Format: Journal Article
• Language: English
• Published: 22.01.2018
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.49.suppl_1.TMP18

Abstract only Background and purpose: Unfractionated Heparin (UFH) infusion represents the most commonly used therapy in the acute management of cerebral venous sinus thrombosis (CVST). effectiveness of heparin in reaching therapeutic anti-coagulation levels has not been well studied in this population. Identifying subgroup of patients who will not respond to Heparin may prove useful in studying alternative treatments such as the new oral anticoagulants and endovascular therapy. We aimed to evaluate the initial response to heparin infusion measured by partial thromboplastin time (PTT) and it implication in discharge outcome. Methods: Retrospective review of all consecutive patients at University of Iowa Hospitals and Clinics between 2004-2014 with CVST was conducted. All patients were treated with initial weight based bolus (14units/kg) of UFH followed by infusion. Consecutive PTT values in the first 48hrs of admission were classified as either therapeutic (40-87), supra-therapeutic (>87), or resistant (<40). Then patients were classified as good responders if 80% of PTT values were in the therapeutic range, classified as adequate if 65-79% of PTT values were therapeutic; rest of patients were classified as non-responders. Univariate and multivariate regressions models were performed to assess the association with discharge mRS, the primary outcome. Results: 115 patients met inclusion criteria (76 women), mean age was 42. Mean PTT was 44.8 (SD=18.6; 95%CI of 41.2-48.5) in the first 48 hours. Patients resistant to Heparin (44%) had significantly worse functional outcomes, mRS [95%CI 2.3-3.6], compared to good [41%, 95%CI 1.2-2.3] and adequate responders to Heparin [15%, 95%CI 0.5-2.3] (p=.003). Mean PTT in the first 48 hours predicted discharge mRS, r=-.28,p<.005 and this effect remained significant when age, sex, altered mental status at admission were controlled, p=.001. Conclusion: A significant portion of patients that receive heparin do not reach therapeutic levels within the initial days after hospitalization, and this does not appear to be a consequence of disease burden in our population. Specifying clinical features that predict heparin resistance might help to identify patients that benefit from alternative anticoagulation therapies.