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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Ventriculostomy related hemorrhage after treatment of acutely ruptured aneurysms: The influence of anticoagulation

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  • Markus Bruder - Klinik für Neurochirurgie, Johann Wolfgang Goethe Universität, Frankfurt am Main
  • Patrick Schuss - Klinik für Neurochirurgie, Johann Wolfgang Goethe Universität, Frankfurt am Main
  • Jürgen Konczalla - Klinik für Neurochirurgie, Johann Wolfgang Goethe Universität, Frankfurt am Main
  • Ahmed El-Fiki - Klinik für Neurochirurgie, Johann Wolfgang Goethe Universität, Frankfurt am Main
  • Joachim Berkefeld - Institut für Neuroradiologie, Johann Wolfgang Goethe Universität, Frankfurt am Main
  • Hartmut Vatter - Klinik für Neurochirurgie, Johann Wolfgang Goethe Universität, Frankfurt am Main
  • Volker Seifert - Klinik für Neurochirurgie, Johann Wolfgang Goethe Universität, Frankfurt am Main
  • Erdem Güresir - Klinik für Neurochirurgie, Johann Wolfgang Goethe Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMO.09.03

doi: 10.3205/15dgnc040, urn:nbn:de:0183-15dgnc0409

Published: June 2, 2015

© 2015 Bruder et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Endovascular techniques have gained importance in the treatment of acutely ruptured aneurysms over the last years. Sometimes artificial anticoagulation is indicated after endovascular aneurysm occlusion to prevent thromboembolic complications. Since many patients require ventriculostomy because of hydrocephalus we analyzed ventriculostomy related hemorrhage in patients with and without anticoagulant therapy.

Method: Between January 2007 and December 2013, 444 patients were treated with aneurysmal subarachnoid hemorrhage (SAH) and acute hydrocephalus requiring ventriculostomy. Treatment related complications were entered in a prospectively conducted database and analyzed retrospectively.

Results: In 117 of the 444 patients (26%) anticoagulant agents were administered after treatment of the ruptured aneurysm. Of these 117 patients, heparin was used in 70 (60%), ASA was used in 61 (52%), Clopidogrel in 25 (21%), and Tirofiban in 23 patients (20%). In 43 patients (29%) anticoagulants and antiplatelet drugs were combined. Overall, ventriculostomy related hemorrhage was observed in 54 patients (12.2%). In 28 of 117 patients (24%) with, and in 27 of 327 patients (8.3%) without anticoagulation therapy a ventriculostomy related hemorrhage occurred (P<0.001). However, no surgical intervention due to ventriculostomy related bleeding was necessary.

Conclusions: Patients, treated with anticoagulation after aneurysm occlusion, were at higher risk for ventriculostomy related hemorrhage. Although there was no need for surgical intervention, ventriculostomy should be performed before anticoagulation whenever possible.