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SDH with Bleeding Diathesis-a Management Protocol.

Gurneet Singh Sawhney1, Cecil R Ross2, Manmeet Singh Chhabra1

  • 1Department of Neurosurgery, St. John's Medical College, Sarjapur Road, Bangalore, 560034 India.

The Indian Journal of Surgery
|June 16, 2016
PubMed
Summary

Managing bleeding risk in elderly patients undergoing surgery for subdural hematoma (SDH) is crucial. This study found that specific blood product dosing and surgical techniques effectively prevented bleeding complications in patients on antiplatelet or anticoagulant medications.

Keywords:
AnticoagulantsAntiplateletsEmergencyMinicraniotomyProtocolSDH

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Area of Science:

  • Neurosurgery
  • Hematology

Background:

  • Chronic subdural hematoma (SDH) is a significant cause of morbidity and mortality in the elderly.
  • Patients on antiplatelet or anticoagulant therapy face increased perioperative bleeding risks during SDH surgery.

Purpose of the Study:

  • To evaluate the efficacy of precise blood product dosing and surgical techniques in preventing hemorrhagic complications in elderly patients with SDH on antiplatelet and/or anticoagulant medications.

Main Methods:

  • A retrospective study of 25 elderly patients on antiplatelet and/or oral anticoagulants undergoing emergency SDH surgery between January 2010 and December 2012.
  • Patients were categorized into three groups based on medication: antiplatelets only, oral anticoagulants only, or both.
  • Interventions included minicraniotomy with microsurgical membranectomy or burr hole craniostomy, with administration of random donor platelet concentrate (RDPC) and/or fresh frozen plasma (FFP) based on medication use.

Main Results:

  • No intraoperative bleeding complications or postoperative rebleeding occurred in any of the 25 patients.
  • Patients on antiplatelets received a mean of 7 units of RDPC; those on oral anticoagulants received a mean of 4 units of FFP; and those on both received a mean of 7 units of RDPC and 4 units of FFP.
  • All patients experienced successful intraoperative hemostasis and favorable postoperative outcomes regarding bleeding.

Conclusions:

  • A specific protocol for blood product administration (RDPC for antiplatelets, FFP for anticoagulants) combined with tailored surgical approaches effectively prevents perioperative bleeding in SDH patients on antithrombotic therapy.
  • This strategy ensures safe surgical management and reduces the risk of rebleeding in this high-risk patient population.