title: Fibrinolytic therapy versus craniotomy for anticoagulant-associated intracerebral hemorrhage.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurosurgery, Georg-August-University, Robert Koch Strasse 40, 37075 Goettingen, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Rohde
authors.forename: Naureen
authors.initials: N
authors.lastname: Uzma
authors.forename: Ina
authors.initials: I
authors.lastname: Rohde
authors.forename: Eric
authors.initials: E
authors.lastname: St Clair
authors.forename: Uzma
authors.initials: U
authors.lastname: Samadani
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000401:mortality / Q000628:therapy*; D003399:Craniotomy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D023261:Glasgow Outcome Scale; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D011994:Recombinant Proteins; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator