Article
Impact of anticoagulants in elderly patients with sella pathologies
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Authors
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Yawen Wang
- Klinik für Neurochirurgie, Vivantes Klinikum Berlin Friedrichshain, Berlin, Deutschland
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Stefanie Hammersen
- Klinik für Neurochirurgie, Vivantes Klinikum Berlin Friedrichshain, Berlin, Deutschland
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Dag Moskopp
- Klinik für Neurochirurgie, Vivantes Klinikum Berlin Friedrichshain, Berlin, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Old patients are at high thromboembolic risk, but also at high hemorrhagic risk. As the proportion of elderly patients increases, we are facing age- related complications such as drug- induced hemorrhage. This study demonstrates the incidence of bleeding complications and evaluates the role of anticoagulants as a prognostic factor in a cohort with old patients with sella pathologies.
Methods: We identified all patients > 70 years with sella pathologies from 2007-2015. Sella pathologies were categorized according to entitiy and frequency. We then investigated the incidence of bleeding complications and the association with the use of anticoagulants.
Results: 256 patients presented to our department with sella pathologies from 2007-2015. 40/256 patients (15%) were 70 years and over. 32/40 patients underwent transsphenoidal surgery, 1/40 patient transcranial surgery, 7/40 received non-surgical treatment. The most frequent sella pathology in our series of patients > 70 was non-functioning pituitary adenoma (26), followed by craniopharyngioma (2), chordoma (2), pituitary apoplexy (2), lymphoma (2), hemorrhagic Rathke's cleft cyst (1), xanthogranuloma (1), hemorrhagic prolactinoma, nasopharyngeal carcinoma (1), mucocele (1) and meningioma (1). The average age of our patients was 76 years. The oldest patient was 85-year-old. Prior to surgery the most frequent symptoms were chiasmal syndrome and hypopituitarism. 50% of the patients (16/32) received anticoagulant therapy prior to admission (Aspirin 8, Vitamin K antagonist 5, Xarelto 3). All hemorrhagic complications were related to drug-induced bleeding disorder (4/32). Neurological deficits were induced by bleeding complications and always required immediate treatment.
Conclusion: In our cohort with elderly patients there is a high prevalence of anticoagulation therapy. Routine preoperative coagulation tests may miss coagulation abnormalities caused by anticoagulants. Expanded coagulation tests such as platelet function test should be established to reduce the risk of hemorrhage prior to surgery.
