Artikel
Impact of anticoagulation and antiplatelet treatment in ventriculostomy related hemorrhages after aneurysmal subarachnoid hemorrhage
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: The frequent utilization of endovascular techniques for the treatment of ruptured intracranial aneurysms is linked with an increase necessity to administer anticoagulation or antiplatelet (AC/AP) drugs to prevent patients from secondary thromboembolic insults. While many patients with an aneurysmal subarachnoid hemorrhage (aSAH) develop an acute and/or chronic hydrocephalus the impact of AC/AP application on the development of external ventricular drainage (EVD)-related hemorrhages after ventriculostomy (VS) is hardly defined.
Method: From 11/2010-09/2015 all patients with a proven aSAH and performed VS during the disease course were included in this retrospective, single-center analysis. Patients were stratified by the presence of AC/AP drugs pre-, peri- or postoperative to the VS. The rate and dimension of the EVD-related hemorrhage was assessed and Chi-square-test, student's T-Test and Mann-Whitney-u-Test were used for statistical analyses.
Results: 163 patients of 191 with VS fulfilled the inclusion criteria. 127 patients (77.9%) received endovascular treatment, while in 36 patients the aneurysm was occluded by microsurgical clipping (22.1%). The overall rate of EVD related hemorrhages was 9.9% (19/191). VS performed under AC/AP medication had a hemorrhage rate of 4.7% (2/43), while EVD without any AC/AP treatment had a higher rate of 11.5% (17/148). If a continuous AC/AP treatment after EVD and treatment of the aneurysm was necessary the EVD-related hemorrhage rate was 12.4% with (12/97) in contrast to 7.4% (7/94) without ongoing AC/AP treatment (Odds ratio 1.755; 95% confidence interval 0.659-4.670; p=0.256). The dimension of the EVD-related hemorrhage under AC/AP treatment was larger than hemorrhages without an AC/AP treatment (3.41qcm3 ± 5.49qcm3 vs. 9,57qcm3 ± 11.93qcm3) but failed to be statistically significant (p=0.13). None of the hemorrhages required a surgical intervention. In 23 patients VS was necessary due to placement of a VP-Shunt. All (3/23, 13.0%) VS-related hemorrhages occurred in patients with ongoing AC/AP treatment at the time of the VP-Shunt placement (p=0.014).
Conclusions: The overall rate of EVD-related hemorrhage in this analysis was 9.9%. Treatment with AC/AP increased the risk for hemorrhage but failed to be statistically significant in this single-center analysis.