Artikel
Management of prehaemorrhage antiplatelet use in aneurysmal subarachnoid haemorrhage – an international survey of current practice
Gebrauch von Plättchenhemmer vor stattgehabten Subarachnoidalblutung – internationale Umfrage über das Management und aktuelle Praxis
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Veröffentlicht: | 8. Mai 2019 |
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Objective: The case fatality in aneurysmal subarachnoid hemorrhage (aSAH) is 50% due to the initial hemorrhage or subsequent complications such as aneurysmal rebleed or delayed cerebral ischemia (DCI). One factor that might influence the initial brain damage or subsequent complications is the use of antiplatelet medication before the initial hemorrhage. The goal of this survey was to assess the different management options of patients with aSAH who used antiplatelets before the initial hemorrhage.
Methods: An anonymous survey of 11 multiple-choice questions about the management of aSAH patients who used antiplatelets before the initial hemorrhage was distributed to the international panel of attendees of the European Association of Neurosurgical Societies (EANS) annual meeting in Venice, Italy at 1–5 October 2017.
Results: A total of 258 (54%) completed surveys were returned. In about 80%, the departments of neurosurgery and neurology were responsible for the acute management of aSAH patients, whereas in 15% it was the intensive care units. Department guidelines were present in 32%. In 65%, the responders always stop the antiplatelet agent at admission and in 4.3% thrombocytes are always transfused. If a guideline is present, the neurospecialists consider thrombocyte transfusion more often (83% vs. 65% p=0.02).
Conclusion: Our survey among mainly European neurosurgeons show that there is a significant variability in the management of aSAH patients who have been using antiplatelets before the initial hemorrhage. These findings emphasize the importance of the development of evidence-based guidelines for management of patients with aSAH and antiplatelet use before the initial hemorrhage.