phenprocoumon and Hematoma--Subdural

The coincidence of coagulatopathy and chronic subdural haematoma (CSH) requires correction of coagulation to facilitate surgery. We investigated the correlation between coagulopathy and outcome in CSH patients.. We analysed past medical history, surgical treatment and coagulation parameters of 114 patients.. Coagulation disorders were found in 42%. Preoperative treatment with prothrombin complex concentrate was necessary in 14%. A significant difference (P < 0.05) of the preoperative level of platelets was found between recurrent CSH and non-recurrent group. Totally, we had to perform re-operations in 17.5%. Eighty-one patients presented with Glasgow coma scale (GCS) > or = 13. After surgery GCS was > or = 13 in n = 92. There was an improvement of GCS in 46 cases, 61 patients maintained GCS score levels. Outcome was significantly worse in the alcoholic group (P < 0.001), and in the recurrent group (P < 0.05). In patients with substitution of coagulation factors, outcome was worse in the group with post-operative substitution only (P < 0.05).. In CSH, the coagulation parameters and a subtle correction of coagulation are of special interest, regarding the worse outcome in patients with recurrent CSH and in those requiring post-operative substitution.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alcoholism; Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Chronic Disease; Craniotomy; Factor XIII Deficiency; Female; Glasgow Coma Scale; Hematoma, Subdural; Humans; Male; Middle Aged; Phenprocoumon; Platelet Count; Postoperative Hemorrhage; Preoperative Care; Recurrence; Reoperation; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome

Oral anticoagulation is a common prophylactic therapy for several diseases with a high thromboembolic risk. Such medication harbors a possible hemorrhage risk, with a special risk for subdural hematoma (SDH). The safety and efficacy of resumption of oral anticoagulation versus long-term discontinuation has not been fully clarified in patients who experienced SDH while under treatment with oral anticoagulation.. We investigated the outcome of 49 patients who were identified retrospectively to have a SDH while receiving oral anticoagulation.. Most bleeding occurred while patients were within the recommended therapeutic window for oral anticoagulation. Mortality was 15%. The event-free survival probability was higher in the group of patients with reinstitution of phenprocoumon therapy than in the group without. Over a median follow-up of 32 months, thromboembolic events occurred in 4 of 23 patients without oral anticoagulation versus in none of 15 patients with phenprocoumon; hemorrhagic complications occurred in 1 in 23 versus 3 in 15 patients.. Reinstitution of oral anticoagulation with phenprocoumon after previous SDH appears to have an acceptable risk for hemorrhagic complications. Decision making might consider case-by-case differences. To establish specific guidelines, prospective large cohort studies are needed.

Topics: Aged; Aged, 80 and over; Anticoagulants; Disease-Free Survival; Female; Follow-Up Studies; Hematoma, Subdural; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Phenprocoumon; Retrospective Studies; Thromboembolism; Treatment Outcome; Warfarin

We report on the case of a spontaneous intracranial hypotension with subdural hygroma, as well as cerebral venous thrombosis (CVT), both known complications of intracranial hypotension. The 45-year-old patient was subsequently treated - according to current guidelines for CVT - with anticoagulation, but developed subdural haematoma (SDH), which required neurosurgical treatment. Our case highlights the complex pathophysiological sequelae of intracranial hypotension, as well as the occasionally difficult treatment decisions. Subdural hygroma probably predisposes patients to SDH during anticoagulation. Thus, the potential benefit of anticoagulation needs to be weighed against the risk of SDH on an individual basis.

Topics: Anticoagulants; Brain; Hematoma, Subdural; Humans; Intracranial Hypotension; Intracranial Thrombosis; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Phenprocoumon; Subdural Effusion; Venous Thrombosis

We report on a 32-year old female patient with primary antiphospholipid syndrome (PAPS) and several thromboembolic events despite stable doses of oral anticoagulation, good patient compliance and maintained INR values of >3. Over the preceding 3 years the patient had presented a wide spectrum of manifestations of APS, including recurrent venous and arterial thromboses, cardiac, gynecological (HELLP syndrome), neurological involvements, livedo reticularis, a mild thrombocytopenia and the most feared manifestation of the catastrophic antiphospholipid syndrome (CAPS). Life-threatening bilateral subdural bleeding occurred while she was anticoagulated. The clinical features appeared to be refractory to oral anticoagulation with phenprocoumon. They were life threatening on each occasion and she developed repetitive episodes of organ damage with cardiac insufficiency (NYHA III), pulmonary hypertension and other residual defects. Even during heparinization recurrent thromboembolism supervened as well as livedo reticularis of the extremities. Lupus anticoagulants (LAC), anticardiolipin (aCL) antibodies and anti-beta(2)-glycoprotein-1 (beta(2)GPI) titers were all markedly elevated. This case report shows that recurrent episodes of thrombosis can occur despite seemingly adequate anticoagulation in patients with CAPS.

Topics: Administration, Oral; Adult; Anticoagulants; Antiphospholipid Syndrome; Female; Hematoma, Subdural; Humans; International Normalized Ratio; Phenprocoumon; Pregnancy; Recurrence; Thromboembolism

A 75-year-old man on anticoagulant therapy suddenly experienced an excruciating back pain and subsequently developed a paraplegia. At operation a subarachnoid and a subdural haematoma were found, extending between the levels of the vertebrae T3 and L2. This extremely rare combination of haematomas may have been caused either by rupture of a small vessel in the arachnoid membrane or by rupture of the arachnoid membrane itself, secondary to a massive haemorrhage in the subarachnoid space.

Topics: Aged; Hematoma, Subdural; Humans; Male; Neurologic Examination; Phenprocoumon; Postoperative Complications; Spinal Cord Compression; Subarachnoid Hemorrhage; Thrombophlebitis; Tomography, X-Ray Computed

From 1978-1986, 63 patients (48-79 years) under coumarin derivatives had to be hospitalized neurosurgically because of intracranial or intraspinal bleedings. This corresponds to a twelvefold increased risk compared to the untreated people. The male/female ratio was 1.5. At the time of the bleeding there was no true indication for anticoagulation in at least 60% of the patients. 80% with coma on admission died. Only for 2/7 with an intraspinal hemorrhage the outcome was better than paraplegic. Women proved to have a better chance of survival. There is a need for more concise indications for chronic anticoagulation.

Topics: Acenocoumarol; Aged; Cerebral Hemorrhage; Coma; Coumarins; Female; Follow-Up Studies; Hematoma, Subdural; Hemorrhage; Humans; Male; Middle Aged; Paraplegia; Phenprocoumon; Risk Factors; Spinal Cord Diseases