PMID- 31675713
OWN - NLM
STAT- MEDLINE
DCOM- 20200922
LR  - 20200922
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 47
IP  - 5
DP  - 2019 Nov 1
TI  - Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic 
      complications in patients with traumatic brain injury undergoing craniotomy or 
      craniectomy.
PG  - E3
LID - 2019.8.FOCUS19546 [pii]
LID - 10.3171/2019.8.FOCUS19546 [doi]
AB  - OBJECTIVE: Traumatic brain injury (TBI) is common among the elderly, often 
      treated with antiplatelet (AP) or anticoagulation (AC) therapy, creating new 
      challenges in neurosurgery. In contrast to elective craniotomy, in which AP/AC 
      therapy is mostly discontinued, in TBI usually no delay in treatment can be 
      afforded. The aim of this study was to analyze the effect of AP/AC therapy on 
      postoperative bleeding after craniotomy/craniectomy in TBI. METHODS: 
      Postoperative bleeding rates in patients treated with AP/AC therapy (blood 
      thinner group) and in those without AP/AC therapy (control group) were 
      retrospectively compared. Furthermore, univariate and multivariate analyses were 
      conducted to identify risk factors for postoperative bleeding. Lastly, a 
      proportional Cox regression analysis comparing postoperative bleeding events 
      within 14 days in both groups was performed. RESULTS: Of 143 consecutive patients 
      undergoing craniotomy/craniectomy for TBI between 2012 and 2017, 47 (32.9%) were 
      under AP/AC treatment. No significant difference for bleeding events was observed 
      in univariate (40.4% blood thinner group vs 36.5% control group; p = 0.71) or Cox 
      proportional regression analysis (log rank chi2 = 0.29, p = 0.59). Patients with 
      postoperative bleeding showed a significantly higher mortality rate (p = 0.035). 
      In the univariate analysis, hemispheric lesion, acute subdural hematoma, 
      hematological disease, greater extent of midline shift, and pupillary difference 
      were significantly associated with a higher risk of postoperative bleeding. 
      However, in the multivariate regression analysis none of these factors showed a 
      significant association with postoperative bleeding. CONCLUSIONS: Patients 
      treated with AP/AC therapy undergoing craniotomy/craniectomy due to TBI do not 
      appear to have increased rates of postoperative bleeding. Once postoperative 
      bleeding occurs, mortality rates rise significantly.
FAU - Greuter, Ladina
AU  - Greuter L
AD  - 1Department of Neurosurgery, University Hospital Basel, and.
FAU - Ullmann, Muriel
AU  - Ullmann M
AD  - 2Faculty of Medicine, University of Basel, Switzerland.
FAU - Mariani, Luigi
AU  - Mariani L
AD  - 1Department of Neurosurgery, University Hospital Basel, and.
AD  - 2Faculty of Medicine, University of Basel, Switzerland.
FAU - Guzman, Raphael
AU  - Guzman R
AD  - 1Department of Neurosurgery, University Hospital Basel, and.
AD  - 2Faculty of Medicine, University of Basel, Switzerland.
FAU - Soleman, Jehuda
AU  - Soleman J
AD  - 1Department of Neurosurgery, University Hospital Basel, and.
AD  - 2Faculty of Medicine, University of Basel, Switzerland.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - Brain Injuries, Traumatic/complications/mortality/*surgery
MH  - Craniotomy/*adverse effects
MH  - Decompressive Craniectomy/*adverse effects
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Postoperative Hemorrhage/*epidemiology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - AC = anticoagulation
OT  - AP = antiplatelet
OT  - ASA = acetylsalicylic acid
OT  - CAD = coronary artery disease
OT  - CVI = cerebrovascular insult
OT  - DOAC = direct-acting oral anticoagulant
OT  - GCS = Glasgow Coma Scale
OT  - INR = international normalized ratio
OT  - TBI = traumatic brain injury
OT  - aSDH = acute subdural hematoma
OT  - anticoagulation
OT  - antiplatelet therapy
OT  - cSDH = chronic subdural hematoma
OT  - hemorrhagic complications
OT  - mRS = modified Rankin Scale
OT  - traumatic brain injury
EDAT- 2019/11/02 06:00
MHDA- 2020/09/23 06:00
CRDT- 2019/11/02 06:00
PHST- 2019/07/01 00:00 [received]
PHST- 2019/08/16 00:00 [accepted]
PHST- 2019/11/02 06:00 [entrez]
PHST- 2019/11/02 06:00 [pubmed]
PHST- 2020/09/23 06:00 [medline]
AID - 2019.8.FOCUS19546 [pii]
AID - 10.3171/2019.8.FOCUS19546 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2019 Nov 1;47(5):E3. doi: 10.3171/2019.8.FOCUS19546.