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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Treatment with direct oral anticoagulants does not increase in-hospital mortality in patients with acute subdural hematoma

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  • Steffen Brenner - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Andreas Unterberg - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Christopher Beynon - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.11.08

doi: 10.3205/17dgnc063, urn:nbn:de:0183-17dgnc0630

Published: June 9, 2017

© 2017 Brenner 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: Direct oral anticoagulants (DOAC) are increasingly used for the treatment and prevention of thromboembolic events. Due to a lack of specific antidotes for the majority of DOAC, concerns exist regarding the management and outcome of respective patients presenting with intracranial haemorrhage. Here we present our experiences with patients suffering from acute subdural haematoma during DOAC treatment and compare the mortality rate to patients treated with vitamin K antagonists (VKA).

Methods: We retrospectively analysed all consecutive anticoagulated patients with acute subdural hematoma treated at our institution between 4/2015 and 6/2016. Patient characteristics as well as treatment modalities were analysed with specific focus on the rate of neurosurgical procedures, pro-haemostatic therapy and in-hospital mortality.

Results: A total of 76 patients were included in this analysis (DOAC: 37; VKA: 39). The median age was 79 years in both groups. The median GCS score on admission was 13 in VKA and 14 in DOAC. Patients treated with VKA received prothrombin complex concentrate significantly more often than patients treated with DOAC, but no significant differences regarding neurosurgical intervention were observed. A total of 34 VKA patients received prothrombin complex concentrate for anticoagulation reversal (87%) and 27 patients underwent neurosurgical intervention (69%). In patients treated with DOAC, 22 patients (59.5%) received prothrombin complex concentrate and 26 patients underwent neurosurgical intervention (70.3%). No differences were observed regarding the in-hospital mortality rates of both groups (DOAC: n=6; 16.2% / VKA: n=7; 17.9%).

Conclusion: Treatment with DOAC was not associated with higher mortality than VKA treatment in patients with acute subdural hematoma. Neurosurgical treatment is feasible and acceptable survival rates can be achieved despite the current lack of specific antidotes to factor Xa-inhibitors. In patients requiring anticoagulation therapy, treatment with DOAC should not be withheld from patients in fear of fatal bleeding complications.