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Related Concept Videos

Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Related Experiment Video

Updated: May 21, 2025

Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model
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Prophylactic anticoagulation in traumatic subdural hematoma.

Florian Wilhelmy1, Michael Gaier2, Gordian Prasse3

  • 1Department of Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. florian.wilhelmy@medizin.uni-leipzig.de.

Scientific Reports
|March 20, 2025
PubMed
Summary

Prophylactic anticoagulation (AC) after severe traumatic brain injury (TBI) with subdural hematoma (SDH) does not increase postoperative intracranial hemorrhage (PH). Delayed AC was associated with PH, not early administration, suggesting AC timing is crucial for patient outcomes.

Keywords:
AnticoagulantNeurosurgeryPerioperative carePostoperative hemorrhageThromboembolismTraumatic brain injury

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Area of Science:

  • Neurosurgery
  • Trauma Surgery
  • Critical Care Medicine

Background:

  • Severe traumatic brain injury (TBI) with acute subdural hematoma (SDH) frequently occurs in neurosurgical patients.
  • Increasingly, TBI patients present with pre-existing conditions like therapeutic anticoagulation (AC) and comorbidities.
  • Low-impact trauma leading to acute-on-chronic subdural hemorrhage is becoming more prevalent.

Purpose of the Study:

  • To investigate the influence of perioperative prophylactic anticoagulation (AC) timing on morbidity and mortality.
  • To analyze the association between AC timing and complications such as postoperative intracranial hemorrhage (PH) and thromboembolic events (TE).
  • To determine if early prophylactic AC impacts the occurrence of PH or TE.

Main Methods:

  • Retrospective analysis of 259 patients with severe TBI and subdural hematoma (SDH) from 01/01/2014 to 31/12/2019.
  • Assessment of biographical and clinical data, focusing on the timing of AC administration and adverse events.
  • Statistical analysis including ROC curve analysis, Mann-Whitney U Test, Chi-square test, Fisher's exact test, and logistic regression.

Main Results:

  • Postoperative intracranial hemorrhage (PH) occurred in 13.1% of patients, with 10.8% requiring surgical revision.
  • PH was correlated with delayed AC (p=0.010), but not with early prophylactic AC (p=0.287).
  • Thromboembolic events (TE) were rare (5.4%), with no correlation to AC timing (p=0.444). Prophylactic AC within 24-48h did not increase PH.

Conclusions:

  • Delayed anticoagulation (AC) is significantly correlated with postoperative intracranial hemorrhage (PH) after TBI with SDH.
  • Early prophylactic AC administration (within 24-48h) does not appear to increase the risk of PH or TE.
  • The findings suggest that PH is not caused by prophylactic AC, and AC timing is a critical factor in managing these patients.