Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Auer, C.
Ergebnisse nach neurochirurgischen Operationen bei antikoagulierten Patienten mit akutem Schädel-Hirn-Trauma. Eine Übersicht über 4 Jahre.
[ Dissertation ] Graz Medical University; 2008. pp.67.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Barth Alain
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- Abstract:
- Objective: The benefit to risk ratio of oral anticoagulation (OAC) and anti-thrombotic agents has been discussed over years in the medical literature. Even without any antecedent trauma, anticoagulation and especially over-anticoagulation can result in an intracranial hemorrhage. In case of head trauma, several studies have demonstrated that OAC and anti-thrombotic therapy is associated with a seven- to ten-fold risk of intracranial hemorrhage. Methods: This was a retrospective review of all medical records of patients suffering acute head trauma that eventually needed neurosurgical intervention over a four years period (between January 2003 and December 2006). There were 231 patients, who were meeting inclusion criteria. Ages ranged between 1 and 99 years (mean 48.9 years). Regarding the use of anticoagulants, 30 (13%) were using OAC or anti-thrombotic medication (group 1); the remaining 201 (87.0%) were not using these agents (group 2). Clinical follow-up could be obtained for 207 patients (89.6%), 67 females and 140 males. Results: Mean age in group 1 was 73.1 years, mean age in the group 2 was 45.3 years (p<0.001). Mean INR in group 1 was 1.8, and 1.2 in group 2 (p=0.059). Quick levels, however, were significantly different between groups (p=0.007). However, mortality was found in 20 of the 30 patients in group 1 (66.66%), and in 61 of the 201 patients in group 2 (30.34%) (p<0.001). Concerning type of medication, mortality was 68.8% in patients with OAC, and 64.3% in patients with anti-thrombotic medication. Mortality was highest in patients with intracerebral hemorrhages (80%), and lowest (8%) in patients with epidural hematoma. Mean GOS was 4.11 in patients with anticoagulation and 2.72 in the patients without anticoagulation (p<0.001). There was significant difference in GOS between comatose and non-comatose patients (p=0.002). The fate of the surviving patients according to Barthel Index, Karnofsky Score and clinical examination was quite favorable, even in group 1, when outcome was matched by age. There were no differences between groups concerning postsurgical neurologic deficit, headache and epilepsy. Conclusion: Age at trauma, comatose status, and intracerebral location of traumatic hemorrhage are still the most significant prognostic factor for outcome after trauma. OAC and anti-thrombotic therapy is associated with a significant risk of fatal outcome after surgically treated intracranial traumatic hemorrhage, especially in case of high-intensity anticoagulant therapy. Clinical outcome of survivors, however, seems to be equal in patient