Improving Outcome in Subarachnoid Hemorrhage wIth Nadroparine (ISCHEMIA)
Aneurysmal Subarachnoid Hemorrhage, Delayed Cerebral Ischemia
About this trial
This is an interventional prevention trial for Aneurysmal Subarachnoid Hemorrhage focused on measuring nadroparin, subarachnoid hemorrhage, brain ischemia, delayed cerebral ischemia
Eligibility Criteria
Inclusion Criteria:
- SAH confirmed by CT or lumbar puncture with the causative aneurysm confirmed by CT-A and/or digital subtraction angiography
- Coiling of the causative aneurysm within 72 hours of initial SAH
- Informed consent within 24 hours after coiling
Exclusion Criteria:
Stent-assisted coiling
- Use of anticoagulant medication post-coiling for other reasons
Contra-indications for LMWH:
- Previous history of history of heparin-induced thrombocytopenia
- (Suspicion of) active arterial or venous bleeding
- Previous history of hemorrhagic diathesis due to coagulation disorders (with the ex-ception of disseminated intravascular coagulation)
- Severe hypertension: uncontrolled hypertension with a mean arterial pressure >135mmHg
- Previous history of hypertensive or diabetic retinopathy
- Previous history of active infectious endocarditis
- Severe renal impairment (creatinine clearance <30 mL / min)
- No proficiency of Dutch or English language
Sites / Locations
- Amsterdam University Medical CentersRecruiting
Arms of the Study
Arm 1
Arm 2
No Intervention
Active Comparator
prophylactic dose LMWH
therapeutic dose LMWH
Patients assigned to the control group will receive standard care according to current protocol with a prophylactic dose of LMWH (nadroparin once daily 2850 AxaIE subcutaneously) starting within 24 hours after coiling, continued until discharge or when mobilized for at least six hours a day.
In the intervention group, the standard prophylactic dose will be replaced by a higher dose of LMWH (nadroparin; twice daily 5700 IE) starting within 24 hours after coiling and continued for 21 days after initial SAH. After this, patients will continue with standard care (prophylactic dose until discharge or when mobilized for more than six hours per day).