gms | German Medical Science

Objective: To investigate the influence of perioperative anticoagulation on the clinical course, outcome, and quality of life (QoL) after surgical treatment of chronic subdural hematoma (CSDH).

Methods: Medical data of 144 patients who underwent surgical evacuation of CSDH between January 2000 and June 2002 were reviewed. Preoperative medication, standard coagulation parameters, haemostaseological risk factors, the type of surgical procedure, and the clinical course were retrieved from the medical charts. The outcome was categorized according to the modified Rankin-Scale (mRS), Barthel-Index (BI), and postoperative quality of life (QoL). All variables were analysed in univariate and multivariate tests.

Results: There was a significant correlation with preoperative ASS medication and reoperation (U-test, p < 0.05). Dosage and duration of postoperative low molecular weight heparin was associated with a higher risk of re-operation (U-test, p < 0.01) and a worse outcome in the mRS (U-test, p<0.05). Preoperative phenprocoumon medication had no influence on the outcome and reoperation since all patients received adequate replacement therapy. Perioperative substitution of prothrombin complex concentrate was associated with poor outcome in the mRS (Craddock-Flood test, p<0.05). The QoL was negatively influenced by female sex, patients with a second trauma or reoperation.

Conclusions: To our knowledge, this is the first report of QoL after surgical evacuation of a CSDH. Assessment of QoL, mRS and BI showed that preoperative medication interfering with the coagulation system has a negative influence on the postoperative outcome after surgical evacuation of a CSDH.