phenprocoumon and Subarachnoid-Hemorrhage

Demographic changes are leading to an aging society with a growing number of patients relying on anticoagulation, and vitamin K antagonists (VKA) are still widely used. As mortality and functional outcomes are worse in case of VKA-associated hemorrhagic stroke, phenprocoumon treatment seems to be a negative prognostic factor in case of subarachnoid hemorrhage (SAH). The purpose of this study was to analyze whether phenprocoumon treatment does worsen the outcome after non-traumatic SAH.. All patients treated for non-traumatic SAH between January 2007 and December 2016 in our institution were retrospectively analyzed. After exclusion of patients with anticoagulant or antiplatelet treatment other than phenprocoumon, we analyzed 1040 patients. Thirty-three patients (3%) of those were treated with continuous phenprocoumon. In total, 132 out of all 1007 patients without anticoagulant treatment of the remaining patients were matched as control group (ratio = 1:4).. Patients with phenprocoumon treatment were significantly older (66.5 years vs. 53.9 years; p < .0001), and admission status was significantly more often poor (66.7% vs. 41.8%, p = .007) compared to all patients without anticoagulant treatment. Further, bleeding pattern and rates of early hydrocephalus did not differ. Matched-pair analysis revealed a significant higher rate of angio-negative SAH in the study group (p = .001). Overall rates of hemorrhagic or thromboembolic complications did not differ (21.4% vs. 18.8%; NS) but were more often fatal, and 30-day mortality rate was significantly higher in the phenprocoumon group than in patients of the matched-pair control group (33% vs. 24%; p < .001). 30% of the phenprocoumon group and 37% of the matched-pair control group reached favorable outcome. However, poor outcome was strong associated with the reason for phenprocoumon treatment.. Patients with phenprocoumon treatment at the time of SAH are significantly older, admission status is worse, and 30-day mortality rates are significantly higher compared to patients without anticoagulant treatment. However, outcome at 6 months did not differ to the matched-pair control group but seems to be strongly associated with the underlying cardiovascular disease. Treatment of these patients is challenging and should be performed on an interdisciplinary base in each individual case. Careful decision-making regarding discontinuation and bridging of anticoagulation and close observation is mandatory.

Topics: Adult; Aged; Aneurysm, Ruptured; Angiography, Digital Subtraction; Anticoagulants; Cerebral Angiography; Female; Functional Status; Humans; Intracranial Aneurysm; Male; Matched-Pair Analysis; Middle Aged; Mortality; Phenprocoumon; Prognosis; Risk Factors; Rupture, Spontaneous; Severity of Illness Index; Subarachnoid Hemorrhage; Vasospasm, Intracranial

Oral anticoagulant therapy with vitamin K antagonists is associated with an increased risk of bleeding, particularly gastrointestinal bleeding. It remains unclear, however, whether use of these medications is a risk factor for subarachnoid haemorrhage (SAH). We therefore examined the association between oral vitamin K antagonist use and risk of SAH.. We conducted this population-based case-control study using medical databases in Northern Denmark (population 1,150,000). We identified 1188 patients admitted to neurologic or neurosurgical departments with a first-time diagnosis of SAH between 1996 and 2008 and 11,880 population controls. We obtained information on use of vitamin K antagonists, other medication use, and comorbidity. We used logistic regression analysis to compute odds ratios (ORs) comparing oral anticoagulant users and non-users, controlling for potential confounding factors.. 9 cases (0.8%) and 157 controls (1.3%) were current users of vitamin K antagonists (at least one prescription filled within 90 days of the diagnosis/index date). Current use of vitamin K antagonists was not associated with increased SAH risk compared with non-use [adjusted OR=0.80 (95% CI: 0.37-1.74)]. Changing the exposure window from 90 days to 120 days or to 60 days before the diagnosis/index date did not change the estimate substantially.. We found no evidence to support an association between use of vitamin K antagonists and increased SAH risk.

Topics: Adolescent; Adult; Aged; Anticoagulants; Case-Control Studies; Confidence Intervals; Female; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Phenprocoumon; Risk Factors; Subarachnoid Hemorrhage; Thromboembolism; Vitamin K; Warfarin; Young Adult

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

Topics: Aged; Cauda Equina; Coumarins; Ependymoma; Humans; Infarction; Male; Myocardial Infarction; Necrosis; Paralysis; Phenprocoumon; Spinal Cord Neoplasms; Subarachnoid Hemorrhage