gms | German Medical Science

Objective: Patients with oral anticoagulation therapy (anti-platelet medication, vitamin K antagonists or factor Xa-antagonists) seem to have higher mortality risks in case of cerebral bleeding in head trauma and spontaneous intracerebral hemorrhage. We sought to investigate the association of spontaneous and traumatic intracerebral hemorrhage with the use of anti-platelet therapy and patient’s outcome in case of cerebral bleeding.

Methods: All patients in the period from April 2007 to November 2016 with traumatic or spontaneous intracranial hemorrhage under anti-platelet medication, vitamin K antagonists or factor Xa-antagonists admitted to the hospital were in a retrospective review included in the study. Age, gender and oral anticoagulant medication of admitted patients were collected. Blood samples for coagulation check (platelet-count and PFA-100 test) were analyzed. Patients with intracerebral hemorrhage were divided into two groups: (a) acute/subacute head trauma and (b) spontaneous intracerebral bleeding. The types of cerebral bleeding (e.g. acute subdural hematoma [aSDH], chronic subdural hematoma [cSDH], traumatic subarachnoidal bleeding [tSAB] and cerebral bleeding [CB] with and without intraventricular hemorrhage [VH]) were defined by CT-scan. The patient’s outcomes after conservative treatment or after operative procedure were recorded.

Results: 405 patients (215 men and 190 women) were identified. The mean age was 74,45 years. 216 (53%) cases of acute/subacute trauma and 189 (47%) cases with spontaneous intracerebral bleeding were registered.

21 patients (9,7%) died in the acute/subacute trauma group and 37 (19,6%) in the spontaneous intracerebral bleeding group. 368 (90,9%) of admitted patients had a single anti-platelet medication. In 9,1% (n=37) a double anti-platelet medication was registered. In 112 patients of the acute/subacute head trauma group operative procedures (hematoma evacuation by craniotomy) were performed. 114 patients received conservative treatment. In 139 patients of the spontaneous intracerebral bleeding group a conservative treatment was done, 50 patients were operated.

Conclusion: There is a high mortality rate for patients with intracerebral hemorrhage associated with oral anticoagulation therapy in acute/subacute head trauma and spontaneous intracerebral bleeding. Continuous follow up of coagulation, platelet-count and additional PFA-100 testing in patients with intracerebral hemorrhage are reasonable. The indication for anti-platelet medication should be done carefully.