Determinants of outcome in anticoagulation-associated cerebral hematoma requiring emergency evacuation.
OBJECTIVE
To analyze the likelihood of recovery and prognostic factors in patients with massive anticoagulation-associated intracerebral hemorrhage treated with surgical evacuation after reversal of anticoagulation.


METHODS
Retrospective case series.


METHODS
Neurological-Neurosurgical Intensive Care Unit at Mayo Clinic. Patients Seventeen consecutive patients with large anticoagulation-associated intracerebral hemorrhage. Intervention Surgical evacuation of intracerebral hemorrhage. Main Outcome Measure Functional outcome was assessed using the modified Rankin scale.


RESULTS
Before surgery, all patients had pronounced (>1-cm) shift of the septum pellucidum and one third had clinical signs of uncal herniation. Still, favorable outcome (modified Rankin scale score < or =3) was achieved by 11 patients (65%). All patients with good recovery awoke within 36 hours of surgery. Older age (P = .05) and serious systemic complications after surgery (P<.01) were significantly associated with lack of neurological recovery and fatal outcome.


CONCLUSIONS
Emergency surgery for select deteriorating patients with large anticoagulation-associated intracerebral hemorrhage is compatible with favorable outcome despite the presence of clinical and radiological signs of herniation before the evacuation.
Rabinstein
Alejandro A
AA
Department of Neurology and Neurological-Neurosurgical Intensive Care Unit, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. rabinstein.alejandro@mayo.edu
Wijdicks
Eelco F M
EF
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000925:Anticoagulants