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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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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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  • corresponding author C. Senft - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • R. Gerlach - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • T. Schuster - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • V. Seifert - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.08.06

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc118.shtml

Published: April 11, 2007

© 2007 Senft et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.