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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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Resumption of anticoagulant treatment after intracranial hemorrhage under phenprocoumon

Orale Antikoagulation nach intrakranieller Blutung unter Phenprocoumontherapie

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  • corresponding author M.J. Mirzayan - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • K. Barth - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • H. H. Capelle - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • J. Weigand - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • J. K. Krauss - Neurochirurgische Klinik, Medizinische Hochschule Hannover

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. DocSO.03.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc224.shtml

Published: April 11, 2007

© 2007 Mirzayan 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: The risk of spontaneous intracranial hemorrhage increases up to 7 to 10 times under treatment with phenprocoumon. Such intracranial hemorrhage is characterized by high mortality and serious morbidity. From a neurosurgical point of view, resumption of anticoagulant treatment with phenprocoumon following intracranial hemorrhage is considered hazardous. This retrospective study was performed to investigate the risk of re-hemorrhage versus the risk of new ischemic events during follow-up after hemorrhage. This data might be helpful in decision-making.

Methods: Between 1995 and 2003, 94 patients suffering from acute intracranial hemorrhage while under treatment with phenprocoumon were admitted to the Department of Neurosurgery. There were 39 women and 55 men with a mean age of 68 years. Twelve patients had sustained a subarchnoid, 52 a subdural, 29 an intracerebral and one patient an epidural hemorrhage.

Indications for anticoagulation were heart valvular transplant, deep vein thrombosis, aortocoronary venous bypass, arrhythmia absoluta, stroke, pulmonary embolism and chronic heart failure. Medical treatment for the intracranial hemorrhage included immediate normalization of the INR, administration of vitamin K, fresh frozen plasma, PPSB and blood transfusions, if necessary. 68 patients underwent a neurosurgical procedure. 43 patients had burrholes and 25 craniotomies. Twenty patients died due to the hemorrhage.

Results: Follow-up was available for 64 patients with a mean period of 6 years. Rebleeding occurred in 9 patients and ischemic stroke in 7 patients. Early resumption of phenprocoumon prophylaxis was not associated with a higher risk of intracranial hemorrhage.

Conclusions: The survival of all patients was better under a re-treatment with phenprocoumon, even following a survived intracranial hemorrhage. A prospective multicenter randomized study will may be able to detect the best time point for resumption. Management of this entity with the increasing number of patients due to the demographic changes remains challenging and hazardous.