gms | German Medical Science

Objective: Endovascular techniques in the treatment of acutely ruptured aneurysms have gained in importance over the last years. In some cases anticoagulant therapy is induced after treatment. Since many patients suffering from SAH require ventriculostomy because of hydrocephalus we analyzed ventriculostomy related hemorrhage in patients with and without anticoagulant therapy.

Methods: Of 583 patients with subarachnoid hemorrhage (SAH) treated between January 2007 and October 2011, 339 (58.1%) underwent ventriculostomy in the presence of hydrocephalus. All patients underwent routine CT-scan during the treatment course. Treatment related complications were entered in a prospectively conducted database and analyzed retrospectively.

Results: In 186 of the 339 patients (54.9%) interdisciplinary decision led to endovascular treatment of the ruptured aneurysm. 163 of the 186 patients (87.6%) required anticoagulation therapy. Heparin was used in 155 patients (95.1%), ASS was used in 52 (31.9%), Clopidogrel in 22 (13.5%), and Tirofiban in 13 patients (8.0%). In 46 of 163 patients (28.2%) more than one anticoagulant drug was used. Overall, ventriculostomy related hemorrhage was observed in 29 of the 339 patients (8.6%). In 19 of 163 patients (11.7%) with, and in 10 of 176 patients (5.7%) without anticoagulation therapy a ventriculostomy related hemorrhage occurred (P < 0.05). However, no surgical intervention due to ventriculostomy related bleeding was necessary.

Conclusions: Patients treated with anticoagulation were at higher risk for ventriculostomy related minor hemorrhage. Although there was no need for surgical intervention, ventriculostomy should be performed before anticoagulation whenever possible.