Antiaggregation and anticoagulation therapy in patients operated on for chronic subdural haematoma as related to pre-surgical status and surgical outcome
Authors:
D. Hrabovský 1; J. Chrastina J 1,2; V. Feitová 3; M. Zvarová 4; I. Říha 1,2; Z. Novák 1,2
Authors place of work:
Neurochirurgická klinika LF MU FN u sv. Anny v Brně, přednosta: prof. MUDr. Z. Novák, CSc.
1; CEITEC MU Brno, ředitel: prof. RNDr. J. Koča, DrSc.
2; Klinika zobrazovacích metod LF MU FN u sv. Anny v Brně, přednosta: MUDr. J. Vaníček, Ph. D.
3; Oddělení klinické hematologie FN u sv. Anny v Brně, primářka: MUDr. M. Zvarová
4
Published in the journal:
Rozhl. Chir., 2014, roč. 93, č. 11, s. 536-544.
Category:
Original articles
Summary
Introduction:
Chronic subdural haematoma is a potentially threatening disease, affecting mainly advanced age patients often with frequent serious complicating diseases and extensive concomitant medication including antiaggregation and anticoagulation treatment. Surgery is indicated in symptomatic patients, with haematoma evacuation and subdural drainage via simple skull trephination in the majority of cases. The study aims to analyse the influence of presurgical anticoagulation and antiaggregation treatment on the severity of pre-surgical clinical status and final surgical outcome including the incidence of complications and haematoma recurrence. Material and methods: The paper retrospectively analyses a group of 132 patients operated on from 2008 to 2013 for chronic subdural haematoma. The following parameters characterising pre-surgical clinical condition were studied: age, anticoagulation and antiaggregation treatment administered, other haemocoagulation problems, interval between the probable injury and surgery, duration of symptoms, the patient’s pre-surgical clinical condition (Glasgow Coma Scale) and the presence of a speech disorder or at least moderate limb paresis. In the postoperative period and subsequent follow- up, the type of surgery, haematoma recurrence, reoperation technique, postoperative complications and final outcome (Glasgow Outcome Scale) were analysed. Results: 64 patients (42 males, 22 females) without antiaggregation and anticoagulation treatment or other medication potentially altering haemocoagulation with normal coagulation parameters (control group), 20 patients (13 males, 7 females) on anticoagulation and 37 patients (30 males, 7 females) on antiaggregation met study inclusion criteria. Anticoagulated patients and patients on antiaggregation were significantly older than the control group patients. Statistical analysis also proved a shorter duration of clinical symptoms and worse clinical condition (GCS) in anticoagulated patients than in the control group. Skull trephination with drainage was the primary surgery indicated in all but one patient, in patients with anticoagulation or antiaggregation after adequate haematological treatment. Although the incidence of reoperation due to haematoma recurrence and postoperative complications was the highest in anticoagulated patients, this difference from the control group did not reach the level of statistical significance. The analysis of clinical outcome (>2 months after surgery) shows a similar proportion of patients with good outcome (Glasgow Outcome Scale 4.5) in all studied groups – control group 82.8%, anticoagulation treatment 80%, antiaggregation treatment 83.8%. Conclusion: Study results did not confirm statistically a significant negative effect of antiaggregation or anticoagulation treatment after adequate pre-surgical preparation on surgical outcomes in chronic subdural haematoma patients (Glasgow Outcome Scale). The highest incidence of complications and haematoma recurrencies was found in anticoagulated patients, although the difference does not reach the level of statistical significance. Key words: chronic subdural haematoma − antiaggregation treatment − anticoagulation treatment
Zdroje
1. Aspegren OP, Astrand R, Lundgren MI, Romner B. Anticoagulationn therapy a risk factor for the development of chronic subdural haematoma. Clin Neurol Neurosurg 2013;115:981−984.
2. Mulligan P, Rarore B, Liu S, Olson JJ. Neurological and functional outcomes of subdural haematoma evacuation in patients over 60 years of age. J Neurosci Rural Pract 2013;4:250–56.
3. Málek V. Chronický subdurální hematom. Neurologie pro praxi 2003;6:307–11.
4. Weir B. Results of burr hole and open or closed suction drainage for chronic subdural hematomas in adults. Can J Neurol Sci 1983;10:22–26.
5. Náhlovský J, et al. Neurochirurgie. Praha, Galén 2006.
6. Plas J, et al. Neurochirurgie. Praha, Galén 2000.
7. Gautschi OP, Gallay MN, Kress TT, Korte WC, Hildebrandt G. Chronic subdural haematoma – assesment and management. Praxis (Bern 1994) 2010;99:1269–77.
8. Almenawer SA, Farrokhyar F, Hong C, et al. Chronic subdural hematoma management: a systematic review and meta – analysis of 34 829 patients. Ann Surg 2014;259:449–57.
9. Horikoshi T, Naganuma H, Fukasawa I, Uchida M, Nukui H. Computed tomography characteristics suggestive of spontaneous resolution of chronic subdural hematoma. Neurol Med Chir (Tokyo) 1998;38:527−33.
10. Bultas J. Antitrombotická léčba při anamnéze krvácivé příhody. Remedia 2008;18:284–86.
11. De Bonis P, Revisi G, de Waure C, et al. Antiplatelet/anticoagulant agents and chronic subdural haematoma in the elderly. PLoS One 2013;8:e 68732.
12. Bartko D, Drobný M. Neurológia. Učebnice pre lekárské fakulty. Martin, Osveta 3. doplněné vydání 1990.
13. Kageyama H, Toyoka T, Tsuzuki N, Oka K. Non surgical treatment of chronic subdural haematoma with transexamic acid. Clinical article. J Neurosurg 2013;119:332–37.
14. Laviv Y, Rappaport ZH. Risk factors for development of significant chronic subdural hematoma following konservative treatment of acute subdural hemorrhage. Br J Neurosurg 2014; May 19,1−6 [E pub ahead of print].
15. Park HR, Lee KS, Shim JJ, Yoon SM, Bae HG, et al. Multiple densities of the chronic subdural hematoma in CT scans. J Korean Neurosurg Soc 2013;54:38–41.
16. Senturk S, Guzel A, Bilici A, et al. CT and MR imaging of chronic subdural haematomas: a comparative study. Swiss Med Wkly 2010;140:335–40.
17. Van Den Veken J, Duerinck J, Buyl R, Van Rompaey K, Herrengodts P, et al. Mini-craniotomy as the primary surgical intervention for the treatment of chronic subdural hematoma – a retrospective analysis. Acta Neurochirurgica (Wien) 2014;156:981– 87.
18. Singh AK, Suryanarayanan B, Choundhary A, Prasat A, Singh S, et al. A prospective randomized study of the use of drain versus no drain after burr hole evacuation of chronic subdural hematoma. Neurol India 2014;62:169−74.
19. Wada M, Yamakami I, Higuchi Y, et al. Influence of antiplatelet therapy on postoperative recurrence of chronic subdural haematoma: a multicenter retrospective study in 719 patients. Clin Neurol Neurosurg 2014;120:49–54.
20. Callovini GM, Bolonini A, Callovini G, Gammone V. Primary enlarged craniotomy in organized chronic subdural hematomas. Neurol Med Chir (Tokyo) 2014;54:349–56.
21. Ohba S, Kinoshita Y, Nakagawa T, Murakami H. The risk factors for recurrence of chronic subdural haematoma. Neurosurg Rev 2013;36:145–9.
22. Okano A, Oya S, Fujisawa N, et al. Analysis of risk factors for chronic subdural haematoma recurrence after burr hole surgery: optimal management of patients on antiplatelet therapy. Br J Neurosurg 2014;28:204–8.
23. Hashimoto T, Ojasni T, Watanabe D, et al. Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas. Surg Neurol Int 2013;4:104.
24. Coulter IC, Kolias AG, Marcus HJ, et al. UK Neurosurgical Research Network, British Neurosurgical Trainee Research Collaborative. Proposal for a prospective multi-center audit of chronic subdural haematoma management in the United Kingdom and Ireland. Br J Neurosurg 2014;28:199–203.
25. Fortuna GR, Mueller EW, James LE, Shutter LA, Hitler KL. The impact of previous antiplatelet and anticoagulant pharmacotherapy on outcome in elderly patiens with hemorrhagic brain injury. Surgery 2008;144:598–603.
26. Santa- Cruz RA, Steinhubl SR. Clopidogrel: How good is it and how does it work? Curr Cardiol Rep 2004;6:264–68.
27. McMillian WD, Rogers FB. Management of prehospital antiplatelet and anticoagulant therapy in traumatic head injury. J Trauma 2009;66:942−50.
28. Mascarenhas L. Illustration of the impact of antiplatelet drugs on the genesis and management of chronic subdural hematoma. Neurochirurgie 2012;58:47–51.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2014 Číslo 11
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Cerebral salt wasting syndrome (CSWS) – rare case from a surgical department
- Pilonidal sinus – diagnosis at the intersection of general and plastic surgery
- Carcinoma of the sigmoid colon in an incarcerated inguinal hernia
- 3D High Resolution Anorectal Manometry in functional anorectal evaluation