Subdural Hematoma and Oral Anticoagulation: A Therapeutic Dilemma from the Neurosurgical Point of View.
J Neurol Surg A Cent Eur Neurosurg
; 77(1): 31-5, 2016 Jan.
Article
en En
| MEDLINE
| ID: mdl-26291887
BACKGROUND: Oral anticoagulation is a common prophylactic therapy for several diseases with a high thromboembolic risk. Such medication harbors a possible hemorrhage risk, with a special risk for subdural hematoma (SDH). The safety and efficacy of resumption of oral anticoagulation versus long-term discontinuation has not been fully clarified in patients who experienced SDH while under treatment with oral anticoagulation. MATERIAL AND METHODS: We investigated the outcome of 49 patients who were identified retrospectively to have a SDH while receiving oral anticoagulation. RESULTS: Most bleeding occurred while patients were within the recommended therapeutic window for oral anticoagulation. Mortality was 15%. The event-free survival probability was higher in the group of patients with reinstitution of phenprocoumon therapy than in the group without. Over a median follow-up of 32 months, thromboembolic events occurred in 4 of 23 patients without oral anticoagulation versus in none of 15 patients with phenprocoumon; hemorrhagic complications occurred in 1 in 23 versus 3 in 15 patients. CONCLUSIONS: Reinstitution of oral anticoagulation with phenprocoumon after previous SDH appears to have an acceptable risk for hemorrhagic complications. Decision making might consider case-by-case differences. To establish specific guidelines, prospective large cohort studies are needed.
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Hematoma Subdural
/
Anticoagulantes
Tipo de estudio:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
J Neurol Surg A Cent Eur Neurosurg
Año:
2016
Tipo del documento:
Article