Coagulopathy and outcome in patients with chronic subdural haematoma.
OBJECTIVE
The coincidence of coagulatopathy and chronic subdural haematoma (CSH) requires correction of coagulation to facilitate surgery. We investigated the correlation between coagulopathy and outcome in CSH patients.


METHODS
We analysed past medical history, surgical treatment and coagulation parameters of 114 patients.


RESULTS
Coagulation disorders were found in 42%. Preoperative treatment with prothrombin complex concentrate was necessary in 14%. A significant difference (P < 0.05) of the preoperative level of platelets was found between recurrent CSH and non-recurrent group. Totally, we had to perform re-operations in 17.5%. Eighty-one patients presented with Glasgow coma scale (GCS) > or = 13. After surgery GCS was > or = 13 in n = 92. There was an improvement of GCS in 46 cases, 61 patients maintained GCS score levels. Outcome was significantly worse in the alcoholic group (P < 0.001), and in the recurrent group (P < 0.05). In patients with substitution of coagulation factors, outcome was worse in the group with post-operative substitution only (P < 0.05).


CONCLUSIONS
In CSH, the coagulation parameters and a subtle correction of coagulation are of special interest, regarding the worse outcome in patients with recurrent CSH and in those requiring post-operative substitution.
König
S A
SA
Klinik für Neurochirurgie, Unfallkrankenhaus Berlin (Department of Neurosurgery, Berlin Trauma Hospital), Germany. koenig_de@web.de
Schick
U
U
Döhnert
J
J
Goldammer
A
A
Vitzthum
H-E
HE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D000925:Anticoagulants / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D001779:Blood Coagulation Factors / Q000008:administration & dosage; D001780:Blood Coagulation Tests; D002908:Chronic Disease; D003399:Craniotomy; D005177:Factor XIII Deficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010644:Phenprocoumon / Q000009:adverse effects; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care; D012008:Recurrence; D012086:Reoperation; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000925:Anticoagulants; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D010644:Phenprocoumon