Fibrinolytic therapy versus craniotomy for anticoagulant-associated intracerebral hemorrhage
| Autor: | Naureen Uzma, Eric St. Clair, Uzma Samadani, Ina Rohde, Veit Rohde |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class medicine.medical_treatment Glasgow Outcome Scale Injections Intralesional Central nervous system disease 03 medical and health sciences 0302 clinical medicine Hematoma Fibrinolytic Agents Fibrinolysis medicine Humans 030212 general & internal medicine Craniotomy Neuronavigation Aged Cerebral Hemorrhage Retrospective Studies Intracerebral hemorrhage business.industry Vascular disease Anticoagulant Glasgow Coma Scale Anticoagulants General Medicine Middle Aged medicine.disease Urokinase-Type Plasminogen Activator Recombinant Proteins 3. Good health Surgery Treatment Outcome Anesthesia Tissue Plasminogen Activator Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Clinical neurology and neurosurgery. 111(6) |
| ISSN: | 1872-6968 |
| Popis: | Object Anticoagulant-associated intracerebral hemorrhages (AAICH) have a high morbidity and mortality, necessitating urgent treatment. We examined outcomes after conventional craniotomy and stereotactic fibrinolytic therapy in a series of patients with anticoagulant-associated hemorrhages. Methods Among 129 consecutive surgically treated patients with supratentorial intracerebral hemorrhage, 27 patients with AAICH were identified (mean age 62; range 36–79). Thirteen patients underwent craniotomy for surgical hematoma evacuation, and 14 patients hematoma puncture and catheter placement for clot lysis. The groups had comparable major prognostic factors such as hematoma volume, age, and Glasgow coma scale (GCS) score at admission. Results Nine patients died despite treatment (mortality = 33%). Mortality in the craniotomy group was comparable to that of the lysis group (46% versus 21%; p = 0.13). Good outcomes (Glasgow outcome score of 4 or 5) were seen in 3 craniotomy patients (23%) and 2 fibrinolysis patients (14%). Half the patients survived with major neurological deficits (GOS 2 or 3) ( n = 13; 48%). One rebleed was observed two days after uneventful craniotomy and hematoma removal, while no patient who underwent fibrinolysis had rebleeding. Conclusions Approximately one-fifth of patients with AAICH managed surgically may have good outcomes. Mortality and favourable outcome rates are comparable between craniotomy and fibrinolytic therapy. Fibrinolytic therapy appears to be a reasonable less invasive alternative treatment modality for intracerebral hemorrhage in the anticoagulated patient. |
| Databáze: | OpenAIRE |
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