Document Detail

Fibrinolytic therapy versus craniotomy for anticoagulant-associated intracerebral hemorrhage.
MedLine Citation:
PMID:  19297083     Owner:  NLM     Status:  MEDLINE    
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.
Veit Rohde; Naureen Uzma; Ina Rohde; Eric St Clair; Uzma Samadani
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-03-17
Journal Detail:
Title:  Clinical neurology and neurosurgery     Volume:  111     ISSN:  1872-6968     ISO Abbreviation:  Clin Neurol Neurosurg     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-02     Completed Date:  2009-10-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7502039     Medline TA:  Clin Neurol Neurosurg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  518-22     Citation Subset:  IM    
Department of Neurosurgery, Georg-August-University, Robert Koch Strasse 40, 37075 Goettingen, Germany.
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MeSH Terms
Anticoagulants / adverse effects*
Cerebral Hemorrhage / chemically induced,  mortality,  therapy*
Fibrinolytic Agents / administration & dosage*
Glasgow Outcome Scale
Injections, Intralesional
Middle Aged
Recombinant Proteins
Retrospective Studies
Tissue Plasminogen Activator / administration & dosage
Treatment Outcome
Urokinase-Type Plasminogen Activator / administration & dosage
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Recombinant Proteins; EC Plasminogen Activator; EC Plasminogen Activator

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