Heparin Treatment in Aneurysmal Subarachnoid Hemorrhage: A Review of Human Studies

  • Nicolas K. Khattar
  • Esther Bak
  • Andrew C. White
  • Robert F. JamesEmail author
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 127)


Aneurysmal subarachnoid hemorrhage (aSAH) remains a significant cause of stroke disability despite gradual reductions in physical morbidity and mortality. Heparin is an effective anti-inflammatory agent and may potentially prevent delayed neurological injury in the days to weeks after the hemorrhage. Various human studies have shown the safety of a continuous infusion of low-dose unfractionated heparin in the setting of subarachnoid hemorrhage as well as its efficacy in minimizing delayed neurological deficits including symptomatic cerebral vasospasm, vasospasm-related infarction, and cognitive dysfunction. Studies have also shown mixed results with low-molecular-weight heparin usage in this patient population. Heparin treatment is not associated with significant hemorrhagic complications; however, vigilance is essential for early detection of heparin-induced thrombocytopenia in order to prevent devastating sequelae. Multicenter randomized controlled trials are necessary for objective characterization of the effects of heparin.


Low-dose IV heparin Enoxaparin Subarachnoid hemorrhage 


Conflict of Interest

RFJ is the study chair for ASTROH, a phase 2 clinical trial evaluating heparin treatment in aneurysmal subarachnoid hemorrhage. We delare that we have no other conflicts of interest with the contents of this manuscript.

Source of Funding: None.


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Nicolas K. Khattar
    • 1
  • Esther Bak
    • 1
  • Andrew C. White
    • 2
  • Robert F. James
    • 1
    Email author
  1. 1.Department of Neurological SurgerySchool of Medicine, University of LouisvilleLouisvilleUSA
  2. 2.Department of RadiologySchool of Medicine, University of LouisvilleLouisvilleUSA

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