Systemic heparin in the early management of ruptured intracranial aneurysms: review of 104 consecutive cases and comparison with concurrent controls.

: The records of 104 patients treated prophylactically with heparin during gradual carotid ligation after rupture of an intracranial aneurysm, 11 patients, who received heparin after the development of an ischemic neurological deficit during clamp closure, and 46 patients who did not receive heparin during clamp closure were reviewed. The incidence of ischemic neurological deficit, both permanent and transient, was 19.2% in the prophylactic heparin group compared with 38.6% in the control group. The incidence of recurrent intracranial hemorrhage was 9.6% in the heparin group vs. 26.1% in the control group. All differences were statistically significant at or below P less than 0.01 by the Mantel-Haenszel statistical test. Possible mechanisms for the reduction in morbidity and mortality in patients receiving heparin are discussed.