Anticoagulation Therapy in Patients Suffering from Aneurysmal Subarachnoid Hemorrhage: Influence on Functional Outcome—a Single-Center Series and Multivariate Analysis

Schuss, Patrick; Hadjiathanasiou, Alexis; Brandecker, Simon; Güresir, Ági; Borger, Valeri; Wispel, Christian; Vatter, Hartmut; Güresir, Erdem

doi:10.1016/j.wneu.2016.12.036

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…12) Moreover, Schuss et al demonstrated that patients without anticoagulation therapy achieved favorable functional outcomes significantly more often than patients with preced-ing anticoagulation therapy. 11) Nevertheless, preceding anticoagulation therapy was not identified as a significant independent predictor of unfavorable outcomes in their multivariate logistic regression analysis. 11) They showed that high age was a more significant risk factor for unfavorable outcomes than preceding anticoagulants.…”

Section: Discussionmentioning

confidence: 93%

“…11) Nevertheless, preceding anticoagulation therapy was not identified as a significant independent predictor of unfavorable outcomes in their multivariate logistic regression analysis. 11) They showed that high age was a more significant risk factor for unfavorable outcomes than preceding anticoagulants. Our study agrees with these results.…”

Section: Discussionmentioning

confidence: 93%

“…Most reports have supported this observation. 11 , 12 , 16 ) Moreover, users of antithrombotic drugs typically show more comorbidities than nonusers. Can et al showed that patients with preceding anticoagulants had more comorbidities without such a history.…”

Section: Discussionmentioning

confidence: 99%

“…In previous reports, frequencies of preceding antithrombotic drugs in patients with nontraumatic SAH were quite variable, at 0%-10.6%. 1,5,7,[9][10][11][12][13] Toussaint et al reported the rate of preceding aspirin as 9.5%, 9) and Schmidt et al demonstrated that 9.2% of SAH patients had preceding antiplatelets. 5) These reported rates are higher than our own findings.…”

Section: Rate Of Preceding Antithrombotic Drugs In Patients With Nont...mentioning

confidence: 99%

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Clinical Presentation, Treatment, and Outcome of Nontraumatic Subarachnoid Hemorrhage in Patients with Preceding Antithrombotic Therapy

Uno

Yagi

Takai

et al. 2023

Neurol. Med. Chir.(Tokyo)

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With the aging of the population, the number of people taking antithrombotic drugs is increasing. Few reports have described the clinical presentation, treatment, and outcomes of nontraumatic subarachnoid hemorrhage (SAH) in patients with preceding antithrombotic therapy. This study included 459 patients with nontraumatic SAH who had been treated between April 2009 and May 2021. Overall, 39 of the 459 patients with aneurysmal SAH were on antithrombotic therapy before ictus (8.5%). Therefore, we classified patients into two groups: Group A (n = 39), patients with preceding antithrombotic therapy and Group B (n = 420), patients without preceding antithrombotic therapy. Hunt and Kosnik (H&K) grade on admission was significantly higher in Group A than in Group B (p = 0.02). Patients in Group A more frequently received endovascular treatment. The rate of endovascular therapy for symptomatic vasospasm after SAH was significantly lower in Group A (2.6%) than in Group B (15.5%; p = 0.03). The outcomes at 3 months after onset were significantly poorer in Group A patients than in Group B patients (p = 0.03). Patients with preceding antithrombotic drugs tended to be at greater risk of unfavorable outcomes, but this difference was not significant in the univariate analysis. In the multivariate analysis, patient age, H&K grade ! 4, and subdural hematoma remained as risk factors for poor outcomes; however, preceding use of antithrombotic drugs was not a significant risk factor.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Rate Of Preceding Antithrombotic Drugs In Patients With Nont...mentioning

confidence: 99%

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Clinical Presentation, Treatment, and Outcome of Nontraumatic Subarachnoid Hemorrhage in Patients with Preceding Antithrombotic Therapy

Uno

Yagi

Takai

et al. 2023

Neurol. Med. Chir.(Tokyo)

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“…Therefore, strategies that reduce microthrombosis in EBI after SAH may be beneficial for SAH treatment. Fortunately, the early administration of antiplatelet medications as well as anticoagulants has been suggested to be beneficial in improving neurological outcomes in some SAH patients (9,10).…”

Section: Introductionmentioning

confidence: 99%

Association of Pericyte Loss With Microthrombosis After Subarachnoid Hemorrhage in ApoE-Deficient Mice

Pang

Peng

et al. 2021

Front. Neurol.

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Background: The occurrence of microthrombosis contributes to not only delayed cerebral ischemia (DCI), but also early brain injury (EBI) after SAH. However, the underlying mechanism is not completely investigated. In the current study, we explored the underlying mechanism of microthrombosis in EBI stage after SAH in ApoE-deficient mice.Methods: Experimental SAH was established by endovascular perforation in apolipoprotein E (ApoE)-deficient mice and wild type (WT) mice. Neurobehavioral, molecular biological and histopathological methods were used to assess the relationship between pericytes loss, neurobehavioral performance, and microthrombosis.Results: We found that the number of microthrombi was significantly increased and peaked 48 h after SAH in WT mice. The increased microthrombosis was related to the decreased effective microcirculation perfusion area and EBI severity. ApoE-deficient mice showed more extensive microthrombosis than that of WT mice 48 h after SAH, which was thereby associated with greater neurobehavioral deficits. Immunohistochemical staining showed that microthrombi were predominantly located in microvessels where pericytes coverage was absent. Mechanistically, ApoE deficiency caused more extensive CypA-NF-κB-MMP-9 pathway activation than that observed in WT mice, which thereby led to more degradation of N-cadherin, and subsequently more pericytes loss. Thereafter, the major adhesion molecule that promoting microthrombi formation in microvessels, P-selectin, was considerably increased in WT mice and increased to a greater extent in the ApoE-deficient mice.Conclusion: Taken together, these data suggest that pericytes loss is associated with EBI after SAH through promoting microthrombosis. Therapies that target ApoE to reduce microthrombosis may be a promising strategy for SAH treatment.

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Initial inflammatory response is an independent predictor of unfavorable outcome in patients with good-grade aneurysmal subarachnoid hemorrhage

Güresir

Coch

Fimmers

et al. 2020

Journal of Critical Care

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Anticoagulation Therapy in Patients Suffering from Aneurysmal Subarachnoid Hemorrhage: Influence on Functional Outcome—a Single-Center Series and Multivariate Analysis

Cited by 8 publications

References 22 publications

Clinical Presentation, Treatment, and Outcome of Nontraumatic Subarachnoid Hemorrhage in Patients with Preceding Antithrombotic Therapy

Clinical Presentation, Treatment, and Outcome of Nontraumatic Subarachnoid Hemorrhage in Patients with Preceding Antithrombotic Therapy

Association of Pericyte Loss With Microthrombosis After Subarachnoid Hemorrhage in ApoE-Deficient Mice

Initial inflammatory response is an independent predictor of unfavorable outcome in patients with good-grade aneurysmal subarachnoid hemorrhage

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