Subdural Hematoma and Oral Anticoagulation: A Therapeutic Dilemma from the Neurosurgical Point of View.
BACKGROUND
Oral anticoagulation is a common prophylactic therapy for several diseases with a high thromboembolic risk. Such medication harbors a possible hemorrhage risk, with a special risk for subdural hematoma (SDH). The safety and efficacy of resumption of oral anticoagulation versus long-term discontinuation has not been fully clarified in patients who experienced SDH while under treatment with oral anticoagulation.


METHODS
We investigated the outcome of 49 patients who were identified retrospectively to have a SDH while receiving oral anticoagulation.


RESULTS
Most bleeding occurred while patients were within the recommended therapeutic window for oral anticoagulation. Mortality was 15%. The event-free survival probability was higher in the group of patients with reinstitution of phenprocoumon therapy than in the group without. Over a median follow-up of 32 months, thromboembolic events occurred in 4 of 23 patients without oral anticoagulation versus in none of 15 patients with phenprocoumon; hemorrhagic complications occurred in 1 in 23 versus 3 in 15 patients.


CONCLUSIONS
Reinstitution of oral anticoagulation with phenprocoumon after previous SDH appears to have an acceptable risk for hemorrhagic complications. Decision making might consider case-by-case differences. To establish specific guidelines, prospective large cohort studies are needed.
Department of Neurosurgery, Medical University Hannover, Hannover, Germany.
M Javad
MJ
Mirzayan
Department of Neurosurgery, Medical University Hannover, Hannover, Germany.
Karoline
K
Calvelli
Department of Neurosurgery, Medical University Hannover, Hannover, Germany.
Hans-Holger
HH
Capelle
Department of Neurosurgery, Medical University Hannover, Hannover, Germany.
Jessica
J
Weigand
Department of Neurosurgery, Medical University Hannover, Hannover, Germany.
Joachim K
JK
Krauss
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006408:Hematoma, Subdural / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010644:Phenprocoumon / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D010644:Phenprocoumon