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  • Prognosis and Postoperative Hematoma Occurrence of Acute Subdural Hematoma with Antiplatelet And/or Anticoagulant Therapy

    Final Number:
    1149

    Authors:
    Hoon Kim; Kwang Wook Jo; Seong Rim Kim MD; Ik Seong Park MD; Min Woo Baik MD; Young Woo Kim MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Acute subdural hematoma is a common traumatic brain injury with a relatively high mortality rate. The number of neurosurgical patients on medication that interferes with platelet and coagulation function has increased over the years. However, no studies have focused on the outcome of acute subdural hematoma patients who receive antiplatelet and/or anticoagulant therapy.

    Methods: We retrospectively analyzed 15 acute subdural hematoma patients who received antiplatelet and/or anticoagulation therapy prior to craniectomy for hematoma evacuation. Clinical outcome was assessed using the Glasgow outcome score. Patients with good recoveries and moderate disabilities were allocated into the good outcome group, whereas those with severe disabilities and vegetative states or those who died comprised the poor outcome group. Risk factors for functional recovery were evaluated using Fisher’s exact test.

    Results: The overall mortality was 25%, with an incidence of postoperative hematoma of 93%. Good outcomes correlated with a preoperative Glasgow coma scale of 9-15(p=0.011), the time from trauma to admission within 4h(p=0.007), the absence of brain herniation(p=0.041), and administration of a single antithrombotic agent(p=0.044).

    Conclusions: Acute subdural hematoma patients who received antiplatelet and/or anticoagulant therapy had very poor surgical outcomes and frequent postoperative hematoma. Rapid transfer of acute intracranial hemorrhage patients to the hospital and early surgical decompression (before brain herniation occurs) are critical for good outcomes. Finally, dual antithrombotic agents are strongly associated with poor outcomes.

    Patient Care: Good outcomes correlated with a preoperative GCS of 9-15, a time interval from trauma to admission within 4h, absence of brain herniation, and administration of a single antithrom- botic agent. The rapid transfer of traumatic brain injury patients is mandatory. In addition, the physician should be aware that dual antithrombotic therapies are related to poor postoperative outcomes in patients with traumatic SDH.

    Learning Objectives: By the conclusion of this session, participants should be able to :1) Good outcomes correlated with a preoperative GCS of 9-15, a time interval from trauma to admission within 4h, absence of brain herniation, and administration of a single antithrom- botic agent. ,2)The rapid transfer of traumatic brain injury patients is mandatory. In addition, the physician should be aware that dual antithrombotic therapies are related to poor postoperative outcomes in patients with traumatic SDH.

    References: 1.Aiyagari V, Testai FD: Correction of coagulopathy in warfarin associated cerebral hemorrhage. Curr Opin Crit Care15:87- 92, 2009 2.Brain Trauma Foundation, American Association of Neuro- logical Surgeons, Joint Section on Neurotrauma and Critical Care: Guidelines for the management of severe head injury. J Neurotrauma 13:641-734, 1996 3.Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al: Surgical management of acute subdural hematomas. Neurosurgery 58(Suppl 3):s16-s24, 2006 4.David M. Panczvkowski, B.S., David O. Okonkwo: Pre- morbid oral antithrombotic therapy and risk for reaccumula- tion, reoperation, and mortality in acute subdural hematomas. J Neurosurg 114:47-52, 2011 5.Jiang J, Zhu C: Experimental and clinical studies of traumatic brain injury in China. Chin Med J 111:180-182, 1998 6.Koç RK, Akdemir H, Oktem IS, Meral M, Menkü A: Acute subdural hematoma: outcome and outcome prediction. Neurosurg Rev 20:239-244, 1997 7.Kyu-Hong Kim: Predictors for functional recovery and mor- tality of surgically treated traumatic acute subdural hemato- mas in 256 patients. J Korean Neurosurg Soc 45:143-150, 2009 8.Leach P, Childs C, Evans J, Johnston N, Protheroe R, King A: Transfer times for patients with extradural and subdural haematomas to neurosurgery in Greater Manchester. Br J Neu- rosurg 21:11-15, 2007 9.Lobato RD, Cordobes F, Rivas JJ, de la Fuente M, Montero A, Barcena A, et al: Outcome from severe head injury related to the type of intracranial lesion a computerized tomography study. J Neurosurg 59:762-774, 1983 10.Merriman E, Bell W, Long DM: Surgical postoperative bleeding associated with aspirin ingestion. Report of two cases. J Neurosurg 50:682-684, 1979 11.Mosenthal AC, Lavery RF, Addis M, Kaul S, Ross S, Marburger R, et al: isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma 52:907-911, 2002 12.Nolan S: Traumatic brain injury: a review. Crit Care Nurs Q 28:188-194, 2005 13.Palmer JD, Sparrow OC, Iannotti F: Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 35:1061-1064, 1994 14.Piotrowski WP, Mühl BJ: Results of surgery in acute subdural hematoma. Unfallchirurg 98:432-436, 1995 15.Sakas DE, Bullock MR, Teasdale GM: One-year outcome following craniotomy for traumatic hematoma in patients with fixed dilated pupils. J Neurosurg 82:961-965, 1995 16.Servadei F, Nasi MT, Giuliani G, Cremonini AM, Cenni P, Zappi D, et al: CT prognostic factors in acute subdural haematomas: the value of the ‘worst’ CT scan. Br J Neurosurg 14:110-116, 2000 17.Servadei F, Nasi MT, Cremonini AM, Giuliani G, Cenni P, Nanni A: Importance of a reliable admission Glasgow Coma Scale score for determining the need for evacuation of posttraumatic subdural hematomas: a prospective study of 65 patients. J Trauma 44:868-873, 1998 18.Servadei F: Prognostic factors in severely head injured adult patients with acute subdural haematomas. Acta Neurochir (Wien) 139:279-285, 1997 19.Vilalta J, Castaño CH, Guitart JM, Rubio E: Reduction of the mortality from acute subdural hematoma. Comparison of 2 series(1979-1982 and 1987-1989) of patients operated on at the Hospital de la Vall d’Hebron. Neurologia 6:247- 250, 1991 20.Wilberger JE, Harris M, Diamond DL: Acute subdural he- matoma: morbidity, mortality, and operative timing. J Neu- rosurg 74:212-218, 1991

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