gms | German Medical Science

Objective: A ruptured intracranial aneurysm is the common cause for a subarachnoid hemorrhage (SAH). However, in up to 15% of patients with SAH no bleeding source could be identified. The role of platelet aggregation inhibitors (PAI) or oral anticoagulation drugs (OAD) and the impact on outcome after non-aneurysmal SAH (naSAH) is unclear. The aim of this study was to evaluate the influence of the use of PAI and OAD on clinical course and clinical outcome of patients with naSAH.

Method: In the period from 2009 to 2015, 80 patients suffering from naSAH were treated at our department. Repetitive angiography was performed in all patients. Patients were divided into two groups according to the use of PAI or OAD (group I: positive history for use of PAI or OAD; group II: no use of PAI or OAD). The clinical course and clinical outcome were analyzed and compared between the two groups. Outcome was assessed according to the modified Rankin Scale (mRS) 6 months after naSAH (mRS 0-2 favorable; mRS 3-6 unfavorable).

Results: 20 of the 80 patients (25%) were included into group I; 60 (75%) patients were included into group II, respectively. The comparison of the two groups revealed no significant difference according to the clinical characteristics and clinical course, including age, gender, Hunt & Hess grade, Fisher grade, early hydrocephalus, the need of VP-shunting and the occurrence of cerebral vasospasm. Patients in group I had significantly more often a history of arterial hypertension compared to group II (90% vs. 42 %, p=0.0002). In group I, 74% of patients achieved a favorable outcome vs. 93% in group II. The difference was not statistically significant.

Conclusions: The results of our study show, that in patients with naSAH, the use of PAI or OAD previous to the ictus has no impact on clinical course and outcome.