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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Prehaemorrhage antiplatelet use in aneurysmal subarachnoid haemorrhage and its impact on clinical outcome

Gebrauch von gerinnungshemmenden Medikamenten vor der stattgehabten Subarachnoidalblutung und die Auswirkung auf klinisches Outcome

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  • presenting/speaker Martina Sebök - Department of Neurosurgery, Amsterdam University Medical Center, Academic Medical Center, Klinik für Neurochirurgie, Amsterdam, Netherlands
  • Emanuela Keller - Universitätspital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland
  • Luca Regli - Universitätspital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland
  • B. A. Coert - Department of Neurosurgery, Amsterdam University Medical Center, Academic Medical Center, Klinik für Neurochirurgie, Amsterdam, Netherlands
  • W. P. Vandertop - Department of Neurosurgery, Amsterdam University Medical Center, Academic Medical Center, Klinik für Neurochirurgie, Amsterdam, Netherlands
  • A. Sardeha - Department of Neurosurgery, Amsterdam University Medical Center, Academic Medical Center, Klinik für Neurochirurgie, Amsterdam, Netherlands
  • D. Verbaan - Department of Neurosurgery, Amsterdam University Medical Center, Academic Medical Center, Klinik für Neurochirurgie, Amsterdam, Netherlands
  • Menno Germans - Universitätspital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV132

doi: 10.3205/19dgnc147, urn:nbn:de:0183-19dgnc1474

Published: May 8, 2019

© 2019 Sebök et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The aim of this study was to investigate whether the rebleed rate and rate of poor outcome were influenced by the use of antiplatelet agents before aneurysmal subarachnoid hemorrhage (aSAH).

Methods: Patients were collected from prospective databases of two tertiary referral centers for aSAH patients. Patients were divided into “antiplatelet user” and “nonuser” according to their use of antiplatelet agents before the initial hemorrhage. With multivariate analyses we assessed the use of antiplatelets regarding rebleed rate and poor outcome, defined as Glasgow outcome Scale 1–3 at 6 months follow-up. In the antiplatelet user group, the impact of thrombocyte transfusion on rebleed rate and poor outcome was calculated.

Results: A total of 1,134 patients were included (15.2% antiplatelet users). Patients in the antiplatelet user group were significantly older with higher incidence of hypertension, diabetes and hypercholesterinemia. Antiplatelet users showed both a significant increase in in-hospital mortality (25.4% vs. 17.0%, p=0.031) as well as poor outcome (57.4% vs. 43.3%, p=0.003). No difference in rebleed rates was seen. In multivariate analysis, antiplatelet use remained associated with poor outcome (OR 1.83, 95% CI 1.22–2.74; p=0.04). Thrombocyte transfusion did not lead to a significant change in rebleed rate or poor outcome (transfusion vs. no transfusion: 11,1% vs. 16,0%, p=0.37 and 59.6% vs. 59.1%, p=0,96, respectively).

Conclusion: In this multicenter study the use of antiplatelet agents before aSAH was associated with increased risk of poor outcome at 6 months without significant increase in rebleed rate. Thrombocyte transfusion had no impact on rebleed or outcome.