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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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Non-traumatic subarachnoid haemorrhage in patients with phenprocoumon anticoagulation treatment – a single-centre, matched pair analysis

Nicht-traumatische Subarachnoidalblutungen bei Patienten unter Antikoagulation mit Phenprocoumon – eine Single-Center, Matched-Pair-Analyse

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  • presenting/speaker Markus Bruder - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Sepide Kashefiolasl - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Nina Brawanski - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Fee Keil - Universitätsklinikum, Neuroradiologie, Frankfurt am Main, Deutschland
  • Sae-Yeon Won - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Volker Seifert - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Jürgen Konczalla - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland

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. DocP127

doi: 10.3205/19dgnc463, urn:nbn:de:0183-19dgnc4637

Published: May 8, 2019

© 2019 Bruder 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

Text

Objective: Demographic changes are leading to a growing number of patients with cardiovascular diseases and phenprocoumon treatment. In case of intracranial aneurysm rupture, anticoagulation seems to be a negative prognostic factor. However, it is unclear whether admission status, age and/or anticoagulation are the reasons for worse outcome.

Methods: All patients treated for non-traumatic SAH between January 2007 and December 2016 in our institution were analyzed. After exclusion of patients with anticoagulant or antiplatelet treatment other than phenprocoumon, we analyzed 1040 patients. 33 patients (3%) of these were treated with continuous phenprocoumon. 132 out of all 1007 remaining patients without anticoagulant treatment were matched as control group (ratio=1:4).

Results: Patients with phenprocoumon treatment were significantly older (66.5 years vs. 53.9 years; p<.0001) and admission status was significantly more often poor (66.7% vs. 41.8%, p=.007). Bleeding pattern and rates of early hydrocephalus did not differ. Matched pair analysis revealed a significantly higher rate of non-aneurysmal SAH in the study group (p=.001). Patients with phenprocoumon had rebleeding of the aneurysm before aneurysm treatment twice as often and the 30day mortality rate was significantly higher than in patients of the matched pair control group (33% vs. 24%; p<.001). 30% of the phenprocoumon group and 37% of the matched pair control group reached favorable outcome. However, a poor outcome was strongly associated with the reason for phenprocoumon treatment.

Conclusion: Patients with continuous phenprocoumon treatment at the time of aneurysm rupture are significantly older, admission status is worse and mortality rates are higher compared to patients without anticoagulant treatment. However, outcome is strongly associated with the underlying cardiovascular disease. Careful adjustment of anticoagulation during treatment of ruptured aneurysm is challenging but mandatory in those patients.

Figure 1 [Fig. 1]