gms | German Medical Science

Objective: New target specific anticoagulants like the direct thrombin inhibitor dabigatran and the factor Xa inhibitor rivaroxaban are used in an increasing number of patients for the treatment of atrial fibrillation and venous thromboembolism. However, the lack of antidotes is a challenging issue in the acute treatment of traumatic or spontaneous intracranial bleeding under these anticoagulation.

Method: A retrospective analysis of patients suffering from intracranial bleeding under new oral anticoagulants that were admitted to our Department of Neurosurgery between 01/2011 and 11/2014 was performed. Treatment, anticoagulant management and outcome of the patients were analyzed.

Results: Seventeen patients were included in this study. The median age was 80.4 years. The patients were treated with dabigatran in 7 cases, with rivaroxaban in 10 cases. Eight patients suffered from traumatic intracranial hemorrhage; 9 patients suffered from spontaneous intracranial bleeding. Complex perioperative hematological treatment followed with fresh frozen plasma, prothrombin complex and Factor VII. In 9 cases, the clinical outcome was devastating with severe neurological deficits (n=2), comatose status (n=4) or death (n=3). Only 4 patients showed a good clinical outcome with only slight deficits. In these cases, surgical treatment was not necessary or was performed delayed after stabilization of blood coagulation.

Conclusions: Few case reports analyzed clinical course and outcome after intracranial bleeding under new target specific oral anticoagulants. In the present study, one of the first bigger series in a single center is analyzed. If an instant surgical treatment was indicated, patient outcome was poor which could be due to the lack of reversibility of the anticoagulative effects and due to the overall risks of these geriatric patient subgroup. So this study indicates that the development of antidotes is highly recommended.