gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Article

Send article

Increased risk of bleeding after elective craniotomies by oral anticoagulants (OAC) and platelet aggregation inhibitors (PAI)

Erhöhtes Blutungsrisiko nach elektiven Kraniotomien unter oralen Antikoagulanzien (OAK) und Thrombozytenaggregationshemmern (TAH)

Meeting Abstract

Search Medline for

  • presenting/speaker Narek Karapetyan - Klinikum Ingolstadt, Neurochirurgie, Ingolstadt, Deutschland
  • Siamak Asgari - Klinikum Ingolstadt, Neurochirurgie, Ingolstadt, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV243

doi: 10.3205/20dgnc237, urn:nbn:de:0183-20dgnc2377

Published: June 26, 2020

© 2020 Karapetyan 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

Text

Objective: Postoperative intracranial hemorrhage (POIH) after craniotomies is associated with significant morbidity and mortality mainly if taking OAC and/or PAI. This retrospective study aims to find out whether intracranial hemorrhages are associated with the use of pre-operatively paused OAC and/or PAI after elective craniotomies.

Methods: In this study, 521 patients underwent elective craniotomies between June 2011 and February 2016. A group of 69 patients (group A) had taken OAC and/or PAI before surgery and were compared with the group of 452 patients (group B) without the use of those drugs, respectively. All anticoagulant and antiaggregant drugs had been paused before surgery. In this multivariate analysis several risk factors were considered as well.

Results: In 521 patients, 33 (6.33%) had POIH and 22 (4.22%) of these 33 patients were associated with clinical neurological deterioration. 9 patients (13%) of group A had suffered from POIH and mostly got a worse outcome. Contrarily, 24 patients of group B developed POIH (5.3%).The risk for POIH with neurological deterioration was 2.7-times higher for group A than for group B. This result was statistically significant (OR = 2.675, p = 0.014).

Conclusion: Despite pausing OAC and/or PAI before surgery and preoperative inconspicuous plasmatic coagulation and platelet count in the routine laboratory, there was a significantly increased risk of POIH with a worse clinical-neurological outcome among patients taking OAC and/or PAI previously. To minimize the risk of POIH in OAC and/or PAI patients and to reduce morbidity and mortality, it would be useful to perform more differentiated coagulation analysis and platelet function analysis before surgery.