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[Neurologic complications caused by anticoagulants and fibrinolytic agents]
H Bewermeyer1, C Hojer, A Schumacher
1Universitätsklinik für Neurologie, Köln.
Insights
Anticoagulation and fibrinolysis therapies can cause neurological disorders and hemorrhages, with varying onset times. Prompt diagnosis via CT scanning and appropriate treatment, including surgery or conservative management, can improve patient outcomes.
Area of Science:
- Neurology
- Hematology
Context:
- Hemorrhagic complications associated with anticoagulant and fibrinolytic therapies.
- Analysis of 126 patients with various types of hemorrhages.
Purpose:
- To investigate the incidence and characteristics of neurological disorders and hemorrhages in patients undergoing anticoagulant and fibrinolytic therapy.
- To evaluate the effectiveness of different treatment modalities and identify factors influencing prognosis.
Summary:
- Neurologic disorders appeared 2-4 years after coumarin therapy, while heparin and streptokinase caused hemorrhages within days.
- CT scanning is crucial for diagnosis; blood clotting typically normalizes after therapy cessation.
- Surgery benefits subdural hematoma and spinal hemorrhage; conservative treatment is preferred for intracerebral, subarachnoid, and peripheral hemorrhages.
- Cerebral hemorrhage had a 70% lethality rate; subarachnoid bleeding and subdural hematoma also showed significant mortality.
- Spinal hemorrhage frequently led to irreversible paraplegia, whereas peripheral lesions tended to improve.
Impact:
- Highlights the risks of anticoagulation and fibrinolysis, emphasizing the need for careful patient selection and monitoring.
- Informs clinical decision-making regarding treatment strategies for different types of hemorrhages.
- Suggests that adherence to contraindications and limiting therapy duration can reduce the risk of central nervous system (CNS) and nerve structure hemorrhages.
Abstract:
We examined 126 patients, of whom 54 had suffered brain hemorrhage, 33 subdural hematoma, 18 subarachnoid bleeding, nine spinal hemorrhage and twelve hematoma with peripheral deficits. Neurologic disorders were seen in patients subject to therapy with coumarins 2-4 years after initiating therapy, whereas hemorrhages under heparine and streptokinase regimes were observed after only a few days. Clotting values were below a therapeutic range in only some of the cases. A clinical diagnosis should be verified by CT scanning. Blood clotting normally recovers after discontinuation of anticoagulation or fibrinolysis. Surgery will improve the prognosis in many cases of subdural hematoma or spinal hemorrhage; conservative treatment in cases of intracerebral, subarachnoid, and peripheral hemorrhage. A 70-percent lethality was recorded for patients suffering a cerebral hemorrhage. More than a third of patients with subarachnoid bleeding and less than a third of cases with subdural hematoma died. While peripheral lesions tended to improve, spinal hemorrhage often resulted in irreversible paraplegia. By respecting contra-indications for anticoagulation therapy and limiting the duration of such regimes the risk of hemorrhage within the CNS and other nerve structures may be reduced. Interactions with other drugs precipitating clotting disorders should also be taken into account.