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  • Optimization of DBS Outcome: Probability of Hemorrhage and Number of Trajectories and Anticoagulation

    Final Number:

    Daxa M Patel MD; Harrison Walker MD; Rebekah Brooks; David F. Bauer MD; Barton L. Guthrie MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Deep brain stimulation (DBS) efficacy can be defined as a balance between good and adverse effects. As part of a comprehensive program to optimize DBS outcome, we evaluate the risk of hemorrhage as it relates to the number of electrode trajectories and use of blood thinners.

    Methods: We queried our DBS database from January 2003 and March 2013 for patients who underwent DBS placement. Records were searched for hemorrhage, number of electrode trajectories, use and type of antiplatelet and anticoagulation therapy. All patients received imaging within 24 hours of the procedure. Statistical analysis using linear regression and conditional probability was performed.

    Results: Complete records were found for 510 patients. Overall intracranial hemorrhage rate was 2.94% and subdural hemorrhage (SDH) rate was 1.76%. GPi DBS procedure was associated with hemorrhage in 4.0% (4/100) of patients, STN DBS was associated with hemorrhage in 2.2% (6/270) of patients, and Vim DBS was associated with hemorrhage in 3.6% (5/140) of patients. The overall conditional probability of a hemorrhage was 0.62% for the second electrode pass, 1.0% for the third pass, 1.8% for the fourth pass, and 10% for the fifth electrode pass. 19% of patients were on blood thinners, including 13.5% on Aspirin, 4.1 % on Coumadin, 3.9% on Plavix, and 0.6% on Pradaxa. 3.3% of patients were on multiple blood thinners. The only correlation found between blood thinners (individually and combined) and development of ICH, SDH, or a combined variable ICH/SDH was the use of coumadin and subdural hemorrhage (p value = 0.0068).

    Conclusions: The incidence of hemorrhagic complication appears higher when targeting the GPi versus targeting VIM or STN. The risk if hemorrhage increases incrementally with the number of electrode trajectories. Additionally, the SDH risk was associated with coumadin, but the risk of overall hemorrhage did not correlate with anticoagulation or antiplatelet therapy.

    Patient Care: It will help optimize DBS outcome and allow accurate estimates of adverse events to better inform patients and caregivers about potential risks and benefits of surgery and provide normative data for process improvement.

    Learning Objectives: 1) Identify risk of ICH and SDH with movement disorders, subcategorized into targets. 2) Identify if use of blood thinners is associated with increased hemorrhage and clarify the relationship between type of blood thinners and hemorrhage. 3) Describe conditional probability of hemorrhage and its relationship with the number of electrode trajectories


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