| Prognosis and Postoperative Hematoma Occurrence of Acute Subdural Hematoma with Antiplatelet and/or Anticoagulant Therapy |
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Jun Sang Park1 , Hyo Chang Kim2 , Seong Joon Kim1 , Jung Kyu Im1 , Ik Seong Park1 , Hoon Kim1 |
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1Department of Neurosurgery, The Catholic University of Korea, Bucheon St. Mary's Hospital
2Department of Neurosurgery, Dongkang Medical Center, Ulsan, Korea |
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| Abstract |
Objective
Acute subdural hematoma is a common traumatic brain injury with a relatively high mortality rate. The number of neurosurgical patients on medication that interferes with platelet and coagulation function has increased over the years. However, no studies have focused on the outcome of acute subdural hematoma patients who receive antiplatelet and/or anticoagulant therapy.
Methods
We retrospectively analyzed 15 acute subdural hematoma patients who received antiplatelet and/or anticoagulation therapy prior to craniectomy for hematoma evacuation. Clinical outcome was assessed using the Glasgow outcome score. Patients with good recoveries and moderate disabilities were allocated into the good outcome group, whereas those with severe disabilities and vegetative states or those who died comprised the poor outcome group. Risk factors for functional recovery were evaluated using Fisher’s exact test.
Results
The overall mortality was 25%, with an incidence of postoperative hematoma of 93%. Good outcomes correlated with a preoperative Glasgow coma scale of 9-15 (p=0.011), the time from trauma to admission within 4 h (p=0.007), the absence of brain herniation (p=0.041), and administration of a single antithrombotic agent (p=0.044).
Conclusion
Acute subdural hematoma patients who received antiplatelet and/or anticoagulant therapy had very poor surgical outcomes and frequent postoperative hematoma. Rapid transfer of acute intracranial hemorrhage patients to the hospital and early surgical decompression (before brain herniation occurs) are critical for good outcomes. Finally, dual antithrombotic agents are strongly associated with poor outcomes. |
| Key Words:
Acute subdural hematomaㆍAntiplatelet agentㆍGlasgow outcome score |
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