Article
Subarachnoid hemorrhage in patients with anticoagulant or antiplatelet drugs
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Authors
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Markus Bruder
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Johannes Platz
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Nina Brawanski
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Nazife Dinc
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Volker Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Jürgen Konczalla
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Demographic changes are leading to an aging society with a growing number of patients relying on antiplatelet or anticoagulant drugs (AAD). Therefore, the number of patients suffering from subarachnoid hemorrhage (SAH) while treated with these drugs is rising. Although antiplatelets are suspected to be protective not only in the cardiological but in the neurovascular field, the alteration of the coagulating process could have a major impact on the course and outcome after rupture of intracranial aneurysms.
Method: 921 patients suffering from aneurysmal SAH were treated between 2007 and 2014 in our department. Patients with an existing antiplatelet or anticoagulant medication until the ictus were identified out of our prospective kept database and treatment course and outcome was analyzed.
Results: Overall, 144 patients (15.6%) were on anticoagulant or antiplatelet drugs (AAD) until the rupture of the aneurysm. 115 patients (12.5%) were treated with ASS, 23 with phenprocoumon (2.5%), and respectively 2 (0.2%) with therapeutic low molecular weights heparin, rivaroxaban and clopidogrel. Patients with AAD were significantly older than patients without (62 ± 1.2 years vs. 53.9 ± 0.5 years; mean ± SD; p<0.001). However, there was no significant difference in admission status, Fisher grade, presence of small or large ICH. Furthermore, the location and treatment modalities were not significantly different. Even though the number of patients with vasospasm (CVS) were equal in both groups. Whereas the rate of mild spasm was significantly higher in patients with AAD (16% vs 9.3%; p<0.01) and the rate of severe spasm was significantly higher in patients without AAD (21.9% vs. 12.9%, p<0.01). Nevertheless, the rate of DCI was not significantly different and patients with AAD had significantly more often an unfavorable outcome (mRS 3-6; 50.4% vs. 37.9%; p<0.005).
Conclusions: Patients under antiplatelet or anticoagulant therapy have the same risk for vasospasm but CVS is more often mild or moderate compared to patients without AAD. However, the presence of AAD seems to be a predictor for unfavorable outcome.
