Christopher Beynon1, Steffen Brenner2, Alexander Younsi2, Timolaos Rizos3,4, Jan-Oliver Neumann2, Johannes Pfaff5, Andreas W Unterberg2. 1. Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. christopher.beynon@med.uni-heidelberg.de. 2. Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. 3. Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. 4. Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany. 5. Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Abstract
BACKGROUND: Anticoagulation therapy is a major risk factor for unfavorable patient outcomes following (traumatic) intracranial hemorrhage. Direct oral anticoagulants (DOAC) are increasingly used for the prevention and treatment of thromboembolic diseases. Data on patients treated for acute subdural hemorrhage (SDH) during anticoagulation therapy with DOAC are limited. METHODS: We analyzed the medical records of consecutive patients treated at our institution for acute SDH during anticoagulation therapy with DOAC or vitamin K antagonists (VKA) during a period of 30 months. Patient characteristics such as results of imaging and laboratory studies, treatment modalities and short-term patient outcomes were included. RESULTS: A total of 128 patients with preadmission DOAC (n = 65) or VKA (n = 63) intake were compared. The overall 30-day mortality rate of this patient cohort was 27%, and it did not differ between patients with DOAC or VKA intake (26% vs. 27%; p = 1.000). Similarly, the rates of neurosurgical intervention (65%) and intracranial re-hemorrhage (18%) were comparable. Prothrombin complex concentrates were administered more frequently in patients with VKA intake than in patients with DOAC intake (90% vs. 58%; p < 0.0001). DOAC treatment in patients with acute SDH did not increase in-hospital and 30-day mortality rates compared to VKA treatment. CONCLUSIONS: These findings support the favorable safety profile of DOAC in patients, even in the setting of intracranial hemorrhage. However, the availability of specific antidotes to DOAC may further improve the management of these patients.
BACKGROUND: Anticoagulation therapy is a major risk factor for unfavorable patient outcomes following (traumatic) intracranial hemorrhage. Direct oral anticoagulants (DOAC) are increasingly used for the prevention and treatment of thromboembolic diseases. Data on patients treated for acute subdural hemorrhage (SDH) during anticoagulation therapy with DOAC are limited. METHODS: We analyzed the medical records of consecutive patients treated at our institution for acute SDH during anticoagulation therapy with DOAC or vitamin K antagonists (VKA) during a period of 30 months. Patient characteristics such as results of imaging and laboratory studies, treatment modalities and short-term patient outcomes were included. RESULTS: A total of 128 patients with preadmission DOAC (n = 65) or VKA (n = 63) intake were compared. The overall 30-day mortality rate of this patient cohort was 27%, and it did not differ between patients with DOAC or VKA intake (26% vs. 27%; p = 1.000). Similarly, the rates of neurosurgical intervention (65%) and intracranial re-hemorrhage (18%) were comparable. Prothrombin complex concentrates were administered more frequently in patients with VKA intake than in patients with DOAC intake (90% vs. 58%; p < 0.0001). DOAC treatment in patients with acute SDH did not increase in-hospital and 30-day mortality rates compared to VKA treatment. CONCLUSIONS: These findings support the favorable safety profile of DOAC in patients, even in the setting of intracranial hemorrhage. However, the availability of specific antidotes to DOAC may further improve the management of these patients.
Authors: Stefan T Gerner; Joji B Kuramatsu; Jochen A Sembill; Maximilian I Sprügel; Matthias Endres; Karl Georg Haeusler; Peter Vajkoczy; Peter A Ringleb; Jan Purrucker; Timolaos Rizos; Frank Erbguth; Peter D Schellinger; Gereon R Fink; Henning Stetefeld; Hauke Schneider; Hermann Neugebauer; Joachim Röther; Joseph Claßen; Dominik Michalski; Arnd Dörfler; Stefan Schwab; Hagen B Huttner Journal: Ann Neurol Date: 2018-01 Impact factor: 10.422
Authors: Jennifer A Frontera; John J Lewin; Alejandro A Rabinstein; Imo P Aisiku; Anne W Alexandrov; Aaron M Cook; Gregory J del Zoppo; Monisha A Kumar; Ellinor I B Peerschke; Michael F Stiefel; Jeanne S Teitelbaum; Katja E Wartenberg; Cindy L Zerfoss Journal: Neurocrit Care Date: 2016-02 Impact factor: 3.210
Authors: Gregoire Boulouis; Andrea Morotti; Marco Pasi; Joshua N Goldstein; M Edip Gurol; Andreas Charidimou Journal: J Neurol Neurosurg Psychiatry Date: 2017-10-13 Impact factor: 10.154
Authors: Leslie Kobayashi; Galinos Barmparas; Patrick Bosarge; Carlos V Brown; Marko Bukur; Matthew M Carrick; Richard D Catalano; Jan Holly-Nicolas; Kenji Inaba; Stephen Kaminski; Amanda L Klein; Tammy Kopelman; Eric J Ley; Ericca M Martinez; Forrest O Moore; Jason Murry; Raminder Nirula; Douglas Paul; Jacob Quick; Omar Rivera; Martin Schreiber; Raul Coimbra Journal: J Trauma Acute Care Surg Date: 2017-05 Impact factor: 3.313
Authors: Taku Inohara; Ying Xian; Li Liang; Roland A Matsouaka; Jeffrey L Saver; Eric E Smith; Lee H Schwamm; Mathew J Reeves; Adrian F Hernandez; Deepak L Bhatt; Eric D Peterson; Gregg C Fonarow Journal: JAMA Date: 2018-02-06 Impact factor: 56.272
Authors: Jan C Purrucker; Kirsten Haas; Timolaos Rizos; Shujah Khan; Marcel Wolf; Michael G Hennerici; Sven Poli; Christoph Kleinschnitz; Thorsten Steiner; Peter U Heuschmann; Roland Veltkamp Journal: JAMA Neurol Date: 2016-02 Impact factor: 18.302
Authors: David Gaist; Luis Alberto García Rodríguez; Maja Hellfritzsch; Frantz Rom Poulsen; Bo Halle; Jesper Hallas; Anton Pottegård Journal: JAMA Date: 2017-02-28 Impact factor: 56.272
Authors: E Herzog; F Kaspereit; W Krege; J Mueller-Cohrs; B Doerr; P Niebl; G Dickneite Journal: J Thromb Haemost Date: 2015-11-24 Impact factor: 5.824
Authors: Waltraud Pfeilschifter; Edelgard Lindhoff-Last; Ali Alhashim; Barbara Zydek; Simone Lindau; Stavros Konstantinides; Oliver Grottke; Ulrike Nowak-Göttl; Christian von Heymann; Ingvild Birschmann; Jan Beyer-Westendorf; Patrick Meybohm; Andreas Greinacher; Eva Herrmann Journal: Neurol Res Pract Date: 2022-05-02
Authors: Alexander Younsi; Lennart Riemann; Cleo Habel; Jessica Fischer; Christopher Beynon; Andreas W Unterberg; Klaus Zweckberger Journal: Neurosurg Rev Date: 2021-07-09 Impact factor: 2.800