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Coagulopathy and outcome in patients with chronic subdural haematoma
S A König1, U Schick, J Döhnert
1Klinik für Neurochirurgie, Unfallkrankenhaus Berlin (Department of Neurosurgery, Berlin Trauma Hospital), Germany. koenig_de@web.de
Insights
Coagulation disorders affect 42% of chronic subdural hematoma (CSH) patients, influencing surgical outcomes. Early correction of coagulation issues is vital for better CSH patient results.
Area of Science:
- Neurosurgery
- Hematology
- Critical Care Medicine
Background:
- Coagulopathy frequently coexists with chronic subdural hematoma (CSH).
- Correction of coagulation is essential for surgical intervention in CSH patients.
- Understanding the impact of coagulopathy on CSH outcomes is crucial.
Purpose of the Study:
- To investigate the correlation between coagulopathy and patient outcomes in chronic subdural hematoma.
- To identify specific coagulation parameters associated with CSH recurrence and surgical success.
Main Methods:
- Analysis of past medical history, surgical treatments, and coagulation parameters in 114 CSH patients.
- Comparison of outcomes between patients with and without coagulation disorders.
- Evaluation of Glasgow Coma Scale (GCS) scores pre- and post-surgery.
Main Results:
- Coagulation disorders were present in 42% of patients.
- Preoperative platelet levels differed significantly between recurrent and non-recurrent CSH groups.
- Outcomes were worse in alcoholic patients, recurrent CSH cases, and those requiring post-operative coagulation factor substitution.
Conclusions:
- Coagulation parameters are significant in CSH management.
- Recurrent CSH and post-operative substitution are associated with poorer outcomes.
- Subtle correction of coagulation is important for improving CSH patient prognosis.
Objective:
The coincidence of coagulatopathy and chronic subdural haematoma (CSH) requires correction of coagulation to facilitate surgery. We investigated the correlation between coagulopathy and outcome in CSH patients.
Material And Methods:
We analysed past medical history, surgical treatment and coagulation parameters of 114 patients.
Results:
Coagulation disorders were found in 42%. Preoperative treatment with prothrombin complex concentrate was necessary in 14%. A significant difference (P < 0.05) of the preoperative level of platelets was found between recurrent CSH and non-recurrent group. Totally, we had to perform re-operations in 17.5%. Eighty-one patients presented with Glasgow coma scale (GCS) > or = 13. After surgery GCS was > or = 13 in n = 92. There was an improvement of GCS in 46 cases, 61 patients maintained GCS score levels. Outcome was significantly worse in the alcoholic group (P < 0.001), and in the recurrent group (P < 0.05). In patients with substitution of coagulation factors, outcome was worse in the group with post-operative substitution only (P < 0.05).
Conclusion:
In CSH, the coagulation parameters and a subtle correction of coagulation are of special interest, regarding the worse outcome in patients with recurrent CSH and in those requiring post-operative substitution.