Antiaggregation and anticoagulation therapy in patients operated on for chronic subdural haematoma as related to pre-surgical status and surgical outcome
Authors:
D. Hrabovský 1; J. Chrastina J 1,2; V. Feitová 3; M. Zvarová 4; I. Říha 1,2; Z. Novák 1,2
Authors‘ workplace:
Neurochirurgická klinika LF MU FN u sv. Anny v Brně, přednosta: prof. MUDr. Z. Novák, CSc.
1; CEITEC MU Brno, ředitel: prof. RNDr. J. Koča, DrSc.
2; Klinika zobrazovacích metod LF MU FN u sv. Anny v Brně, přednosta: MUDr. J. Vaníček, Ph. D.
3; Oddělení klinické hematologie FN u sv. Anny v Brně, primářka: MUDr. M. Zvarová
4
Published in:
Rozhl. Chir., 2014, roč. 93, č. 11, s. 536-544.
Category:
Original articles
Overview
Introduction:
Chronic subdural haematoma is a potentially threatening disease, affecting mainly advanced age patients often with frequent serious complicating diseases and extensive concomitant medication including antiaggregation and anticoagulation treatment. Surgery is indicated in symptomatic patients, with haematoma evacuation and subdural drainage via simple skull trephination in the majority of cases. The study aims to analyse the influence of presurgical anticoagulation and antiaggregation treatment on the severity of pre-surgical clinical status and final surgical outcome including the incidence of complications and haematoma recurrence. Material and methods: The paper retrospectively analyses a group of 132 patients operated on from 2008 to 2013 for chronic subdural haematoma. The following parameters characterising pre-surgical clinical condition were studied: age, anticoagulation and antiaggregation treatment administered, other haemocoagulation problems, interval between the probable injury and surgery, duration of symptoms, the patient’s pre-surgical clinical condition (Glasgow Coma Scale) and the presence of a speech disorder or at least moderate limb paresis. In the postoperative period and subsequent follow- up, the type of surgery, haematoma recurrence, reoperation technique, postoperative complications and final outcome (Glasgow Outcome Scale) were analysed. Results: 64 patients (42 males, 22 females) without antiaggregation and anticoagulation treatment or other medication potentially altering haemocoagulation with normal coagulation parameters (control group), 20 patients (13 males, 7 females) on anticoagulation and 37 patients (30 males, 7 females) on antiaggregation met study inclusion criteria. Anticoagulated patients and patients on antiaggregation were significantly older than the control group patients. Statistical analysis also proved a shorter duration of clinical symptoms and worse clinical condition (GCS) in anticoagulated patients than in the control group. Skull trephination with drainage was the primary surgery indicated in all but one patient, in patients with anticoagulation or antiaggregation after adequate haematological treatment. Although the incidence of reoperation due to haematoma recurrence and postoperative complications was the highest in anticoagulated patients, this difference from the control group did not reach the level of statistical significance. The analysis of clinical outcome (>2 months after surgery) shows a similar proportion of patients with good outcome (Glasgow Outcome Scale 4.5) in all studied groups – control group 82.8%, anticoagulation treatment 80%, antiaggregation treatment 83.8%. Conclusion: Study results did not confirm statistically a significant negative effect of antiaggregation or anticoagulation treatment after adequate pre-surgical preparation on surgical outcomes in chronic subdural haematoma patients (Glasgow Outcome Scale). The highest incidence of complications and haematoma recurrencies was found in anticoagulated patients, although the difference does not reach the level of statistical significance. Key words: chronic subdural haematoma − antiaggregation treatment − anticoagulation treatment
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Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2014 Issue 11
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