gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Prognostic meaning of oral anticoagulation and surgery in patients with non traumatic intracerebral hemorrhages: a statistical analysis of 425 consecutive patients

Prognostische Bedeutung von oralen Antikoagulantien und chirurgischem Eingriff bei nicht traumatischen intrazerebralen Blutungen: eine statistische Analyse von 425 konsekutiv gesammelten Patienten

Meeting Abstract

  • corresponding author M. Scholz - Neurochirurgische Universitätsklinik, Ruhr-Universität Bochum
  • U. Thiem - Abteilung für innere Medizin und Geriatrie, Ruhr-Universität Bochum, Marienhospital Herne
  • K. Schmieder - Neurochirurgische Universitätsklinik, Ruhr-Universität Bochum
  • I. Pechlivanis - Neurochirurgische Universitätsklinik, Ruhr-Universität Bochum
  • M. Engelhardt - Neurochirurgische Universitätsklinik, Ruhr-Universität Bochum
  • A. Harders - Neurochirurgische Universitätsklinik, Ruhr-Universität Bochum

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.10.03

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Scholz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Non-traumatic intracerebral hemorrhage (NTICH) is regarded as an acute neurological disease with a poor prognosis. Publications until now suggested, that patients under oral anticoagulation with vitamin K antagonists have a poorer prognosis than without oral anticoagulation. The role of surgery is not fully determined as yet.

Methods: Between 2000 and 2004 all patients with NTICH as main diagnosis, who were treated at the two campusses of the Ruhr-University were identified consecutively. Demografic, clinical and further data were collected together with other information e.g. coma status on admission, hematoma volume and localization, state of oral anticoagulation. Predictors of intrahospital-/30-days-mortality were analysed using univariant and multivariant (logistic regression) methods.

Results: The mean age of the 425 patients was 71.3 years (average age 68.9 years, standard deviation 12,62 years). 69 (16,2%) patients were treated prior to the onset of hemorrhage with oral anticoagulation. In the face of an overall mortality of 31.8%, 102 of 356 (28.7%) patients not on oral anticoagulation patients and 33 of 69 (47.8%) patients on oral anticoagulation died during their hospital stay (Odds Ratio (OR) 2.28, 95%-confidence intervall (KI) [1.35 ; 3.86]). In the univariant analysis, the variables Glasgow Coma Scale, hematoma volume on admission, age, oral anticoagulation and diabetes mellitus showed an association with mortality. After multvariant analysis and adjustment for factors such as coma status, hematoma volume and others, oral anticoagulation has an unrelated influence on the prognosis (adjusted OR between 2.14 und 2.52). Patients, who were underwent neurosurgery had a 50% better prognosis than patients without surgery.

Conclusions: Oral anticoagulation worsens the prognosis of patients with NTICH. Univariant and multivariant analysis demonstrates an increase of mortality during hospital stay by a factor of 2. Therapy studies dealing with therapy including interventions in the coagulation system are necessary to improve the poor prognosis of patients with intracerebral hemorrhage under oral anticoagulation. The role of surgery remains unclear because patients in this study were not randomised for this treatment.