Clinical Experience in Emergency Surgery for Antithrombotic Drug-Related Intracerebral Hemorrhage

To summarize the clinical experience in emergency surgical treatment of antithrombotic drug-related intracerebral hemorrhage (ATR-ICH) and explore the surgical strategies and key points of perioperative management. A retrospective analysis was conducted on the clinical data of 26 patients with ATR-ICH who underwent emergency surgery in the Department of Neurosurgery of our hospital from January 2023 to December 2024. Targeted coagulation function reversal measures were implemented in all patients preoperatively and intraoperatively. All patients were taking antithrombotic drugs [5 on warfarin, 2 on direct oral anticoagulants (DOACs), 2 on heparin] or antiplatelet drugs (9 on aspirin, 5 on clopidogrel, 3 on aspirin + clopidogrel) when acute intracerebral hemorrhage occurred (including spontaneous intracerebral hemorrhage and posttraumatic intracerebral hemorrhage). Preoperative GCS scores were 6 to 8 in 16 cases and 9 to 12 in 10 cases. The average hematoma volume was 75.6 mL. All patients underwent craniotomy for hematoma evacuation, among which 12 cases received decompressive craniectomy. Early postoperative rebleeding (within 72 h) occurred in 1 case, and 1 case died. At discharge, GOS scores were as follows: 6 cases of good recovery, 12 cases of moderate disability, 5 cases of severe disability, 2 cases of vegetative state, and 1 case of death. The core of emergency surgery for ATR-ICH lies in rapid and effective reversal of coagulation function, strict grasp of surgical timing, refined surgical operation, and multidisciplinary collaboration during the perioperative period. Data from this group of cases show that standardized comprehensive treatment can significantly reduce the rebleeding rate and improve patient prognosis.