Artikel
Management and outcome of patients with acute traumatic subdural hematoma on marcumar therapy
Management und Outcome von Patienten mit akuten traumatischen Subduralhämatomen unter Marcumar-Therapie
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Veröffentlicht: | 11. April 2007 |
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Objective: To report our management and outcome of patients suffering from acute traumatic subdural haematoma (aSDH) while under anticoagulation therapy with marcumar.
Methods: We retrospectively analysed the medical history, preoperative and surgical treatment and coagulation parameters of 112 consecutive patients referred with aSHD between June 2002 and June 2006 and treated surgically.
Results: Among the 112 consecutive patients treated surgically for aSDH haematoma, 4 patients (3,6%) were on marcumar without a history of trauma and were therefore excluded from the study. Among the remaining 108 patients with aSDH, 11 (10.2%) patients were on anticoagulation with marcumar. These patients were older, with a higher percentage of females in this group. Median initial PT level was 23%, median pre-operative GCS was 7. Pre-surgical treatment consisted of administration of PPSB, ATIII, vitamin K and FFP’s. No relevant re-bleedings were observed with our substitution management. Four patients (36.4%) died within the first week after trauma due to the trauma and refractory increased intracranial pressure (n=3) or pneumonia (n=1). In the remaining 7 patients median GCS was 11 after 7 days. One patient died two months after trauma due to heart failure. Median GOS six months after trauma was 4, and the overall mortality was 45%.
Conclusions: The percentage of patients with anticoagulation therapy is surprisingly high among those patients with aSDH. Despite a higher age and increased co-morbidity, the outcome of these patients seems to be similar or even better compared to patients without therapeutic anticoagulation and aSDH when immediate replacement therapy and urgent surgery are carried out.