Neurology Medical News about anticoagulant-associated intracerebral hemorrhage;fibrinolytic therapy vs craniotomy

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Fibrinolytic therapy versus craniotomy for anticoagulant-associated intracerebral hemorrhage
Clinical Neurology and Neurosurgery, 06/15/09

Rohdeac V et al. – Approximately 1/5 of pts with anticoagulant-associated intracerebral hemorrhages (AAICH) managed surgically may have good outcomes. Mortality and favorable outcome rates are comparable between craniotomy and fibrinolytic therapy. Fibrinolytic therapy may be a reasonable less invasive alternative treatment modality for intracerebral hemorrhage in the anticoagulated pt.

Methods

Study of outcomes after conventional craniotomy and stereotactic fibrinolytic therapy in a series of pts with anticoagulant-associated hemorrhages

Results

Of 129 consecutive surgically treated pts with supratentorial intracerebral hemorrhage, 27 with AAICH were identified (mean age 62; range 36–79)
Craniotomy for surgical hematoma evacuation: 13 pts
Hematoma puncture and catheter placement for clot lysis: 14 pts
Comparable major prognostic factors between groups: hematoma volume, age, and Glasgow coma scale (GCS) score at admission
Mortality: 33%; 9 pts died despite treatment
Comparable mortality in craniotomy vs lysis group (46% vs 21%)
Good outcomes (Glasgow outcome score [GOS] of 4 or 5): 3 craniotomy pts (23%); 2 fibrinolysis pts (14%)
Survival with major neurologic deficits (GOS 2 or 3): 13 pts (48%)
2 days after uneventful craniotomy and hematoma removal, 1 rebleed
No pt who had fibrinolysis had rebleeding

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