Heparin therapy for stroke: Hemorrhagic complications and risk factors for intracerebral hemorrhage

Hemorrhages occurred in 16 (3.1%) of 510 patients treated with continuous intravenous heparin for acute cerebral infarction (269), reversible ischemic neurologic deficit (81), or transient ischemic attack (160). Three patients (0.6%) had intracerebral hematomas. Risk factors included abnormal CT within 24 hours of onset of symptoms (3.2%), severe neurologic deficit (2.8%), two acute infarcts by CT (2.1%), known source of embolus (1.3%), and final diagnosis of cerebral infarction (1.1%). The only identifiable risk factor for systemic hemorrhage (GI 1.0%, GU 0.8%, muscle 0.4%, skin 0.1%) was age over 60 years. The incidence of intraspinal hematoma was 0.6%. Two of the intracerebral hematomas were fatal, and mortality was 31% in patients with hemorrhagic complications; however, the risk of CNS hemorrhage was only 0.8%.