[Subdural hematoma and anticoagulant therapy].

Area of Science:

• Neurosurgery
• Hematology
• Pharmacology

Background:

• Subdural hematomas are a significant concern in patients undergoing anticoagulant therapy.
• Anticoagulant-related central nervous system hemorrhages occur in approximately one-third of affected patients.
• Anticoagulant therapy is implicated in 4.8% to 14% of all subdural hematoma cases.

Purpose of the Study:

• To analyze a series of 22 cases of subdural hematomas in patients on anticoagulant therapy.
• To review the literature and compare findings with 150 previously reported cases.
• To identify risk factors, clinical features, and treatment outcomes for this patient population.

Main Methods:

• Retrospective case series analysis of 22 patients.
• Literature review of 150 additional cases.
• Classification of patients based on cranial injury and anticoagulant therapy chronology.
• Evaluation of neurosurgical interventions and reversal agents like protamine sulfate and PPSB.

Main Results:

• Most patients (16/22) received long-term anticoagulation for arterial or heart lesions.
• Dicoumarol or phenylindanedione were the most common anticoagulants (18/22 cases).
• Associated factors included hypertension, other medications, and head trauma (10/22 cases).
• Neurosurgical evacuation was performed for chronic (11), acute (2), and subacute (9) hematomas.
• Nineteen patients had favorable outcomes without sequelae; three patients died post-operatively.

Conclusions:

• Anticoagulant therapy is a critical risk factor for subdural hematomas.
• Hypocoagulability alone may not explain bleeding; other factors are often involved.
• Prompt reversal of anticoagulation and timely neurosurgical intervention improve outcomes.
• Preventive measures are essential for patients on anticoagulant therapy.