Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Yasuda, Clarissa Lin; Morita, Márcia Elisabete; Nishimori, Fernanda Yoshi; Yasuda, Agnes Meri; Alves, Hélvio Leite

doi:10.1590/s0004-282x2003000600023

Cited by 23 publications

(19 citation statements)

References 22 publications

(54 reference statements)

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“…In patients on warfarin requiring immediate neurosurgical intervention, rapid and efficacious reversal to an appropriate international normalized ratio (INR) level is essential as INR levels >1.25 increase postoperative mortality. 11-13 Patients taking antiplatelet medications or direct oral anticoagulants with significant bleeding after trauma or requiring emergent surgery may require careful evaluation and specific reversal agents. 14-17 …”

Section: Introductionmentioning

confidence: 99%

Out-of-Hospital Triage of Older Adults With Head Injury: A Retrospective Study of the Effect of Adding “Anticoagulation or Antiplatelet Medication Use” as a Criterion

Nishijima

Gaona

Waechter

et al. 2017

Annals of Emergency Medicine

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Study Objective Field triage guidelines recommend EMS providers consider transport of head injured older adults with anticoagulation use to trauma centers. However the triage patterns and the incidence of intracranial hemorrhage or neurosurgery in these patients are unknown. Our objective was to describe the characteristics and outcomes of older adults with head trauma transported by EMS, particularly in patients that do not meet physiological, anatomical, or mechanism of injury (Step 1-3) field triage criteria but are taking anticoagulant or antiplatelet medications. Methods This was a retrospective study at 5 EMS agencies and 11 hospitals (4 trauma centers, 7 non-trauma centers). Patients ≥55 years with head trauma who were transported by EMS were included. The primary outcome was the presence of intracranial hemorrhage. The secondary outcome was a composite measure of in-hospital death or neurosurgery. Results 2110 patients were included; 131 (6%) had intracranial hemorrhage and 41 (2%) had in-hospital death or neurosurgery. There were 162 patients (8%) with Step 1-3 criteria. Of the remaining 1948 patients without Step 1-3 criteria, 566 (29%) had anticoagulant or antiplatelet use. Of these patients, 52 (9%) had traumatic intracranial hemorrhage and 15 (3%) died or had neurosurgery. The sensitivity of Step 1-3 criteria was 19.8% (26/131; 95% CI 5.5-51.2%) for identifying traumatic intracranial hemorrhage and 34.1% (14/41; 95% CI 28.9-90.1%) for death or neurosurgery. The additional criterion of anticoagulant or antiplatelet use improved the sensitivity for intracranial hemorrhage (78/131; 59.5%, 95% 42.9-74.2%) and death or neurosurgery (29/41; 70.7%, 95% CI 61.0-78.9%). Conclusions Relatively few patients met Step 1-3 triage criteria. In those who did not have Step 1-3 criteria, nearly 30% had anticoagulant or antiplatelet use. A relatively high proportion of these patients had intracranial hemorrhage but a much smaller proportion died or had neurosurgery during hospitalization. Use of Step 1-3 triage criteria alone is not sufficient in identifying intracranial hemorrhage and death or neurosurgery in this patient population. The additional criterion of anticoagulant or antiplatelet use improves the sensitivity of the instrument with only a modest decrease in specificity.

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Section: Introductionmentioning

confidence: 99%

Out-of-Hospital Triage of Older Adults With Head Injury: A Retrospective Study of the Effect of Adding “Anticoagulation or Antiplatelet Medication Use” as a Criterion

Nishijima

Gaona

Waechter

et al. 2017

Annals of Emergency Medicine

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“…1 These patients often have relatively minor mechanisms of injury and benign clinical presentations yet have significant intracranial injuries. 2 In the presence of traumatic intracranial hemorrhage (tICH), the effects of the anticoagulant or antiplatelet medications increase the risk for hemorrhage progression and bleeding complications during neurosurgery 3–5 Prior studies demonstrate an increased risk for in-hospital mortality in these patients with tICH compared to patients without pre-injury anticoagulant or antiplatelet use. 6–8 However, the impact of pre-injury anticoagulant or antiplatelet use on long-term functional outcomes has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Risk of unfavorable long-term outcome in older adults with traumatic intracranial hemorrhage and anticoagulant or antiplatelet use

Nishijima¹,

Shahlaie²,

Sarkar³

et al. 2013

The American Journal of Emergency Medicine

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Study Objective To compare neurological outcomes at six months in older patients with pre-injury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage (tICH) to those without prior use of these medications. Methods This was a retrospective study conducted at a Level 1 trauma center from April 2009 to July 2010. Patients over 55 years of age with isolated mild head injury (Glasgow Coma Scale Score [GCS] 13 to 15 and Abbreviated Injury Score < 3 in non-head body region) were included. Demographic, clinical, and outcome data were abstracted from an existing TBI database. The primary endpoint of unfavorable extended Glasgow Outcome Score (GOS-E) at 6 months was compared between patients with and without pre-injury warfarin or clopidogrel use. Results Seventy-seven eligible patients were identified; 27 (35%) with pre-injury warfarin or clopidogrel use and 50 (65%) without. Baseline characteristics (gender, GCS score, Injury Severity Score, computed tomography score, and in-hospital mortality) were similar between cohorts although the pre-injury warfarin or clopidogrel cohort was older than the control group (p<.05). Patients in the pre-injury warfarin or clopidogrel cohort were more likely to have an unfavorable outcome (16/27; 59.3%, 95% confidence interval [CI] 40.7–77.8%) as compared to those without (18/50; 36.0%, 95% CI 22.7–49.3%), p=.05. Conclusion Older adults with pre-injury warfarin or clopidogrel use and mild traumatic intracranial hemorrhage may be at an increased risk for unfavorable long-term neurological outcomes compared to similar patients without pre-injury use of these medications.

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“…[20] They are commonly associated with old alcohol-addicted male patients, with a history of head trauma and concomitant coagulopathy. [14101228323335] The mortality rate varies between 8% and 15.6%. [4728] However, specific groups of patients, such as those with coagulation abnormalities and older people, demonstrate a more elevated mortality rate.…”

Section: Introductionmentioning

confidence: 99%

Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old "horses" are not to be shot!

Silva¹,

Gk²,

Lf³

et al. 2012

Surg Neurol Int

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Background:To present the accumulated experience from treating chronic subdural hematomas (CSDH) in a local hospital of a third world country.Methods:One hundred and twenty-five consecutive patients with CSDH who were surgically treated in the Neurosurgical Department of the Hospital da Restauração, Recife-PE, Brazil, between January 2006 and May 2008, were retrospectively studied. Glasgow Outcome Scale (GOS) was employed to define outcome at 6 months as good (GOS 4 and 5) or poor (GOS ≤ 3). Age, admission Glasgow Coma Scale (GCS), location of hematomas (unilateral/bilateral), drainage system placement and recurrence were all analyzed for potential impact on final outcome.Results:The median age was 69 years, with a male/female ratio of 102/23. History of trauma was present in 60.8% of the patients. The median GCS on admission was 14. In 64 patients, the hematoma was on the left side, while in 42 patients it was on the right side. Bilateral hematomas were present in 19 cases (15.2%). Drainage systems were used in 93.6% of the cases. Recurrence occurred in 8.8% of the patients. One hundred and three patients obtained a good outcome at 6 months. The mortality rate was 11.2%. Patients with GCS ≥9 on admission presented better outcome (P < 0.05). Recurrent cases presented a poor outcome (P < 0.05).Conclusions:This study suggests that the main factors associated with outcome in patients harboring CSDH are the admission GCS score and the recurrence status. Advanced age is not a contraindication for surgical treatment. This study, solely focused on the Brazilian population, is the first of its kind in the English literature, and it could serve as a useful introduction to a more complex, multivariate, debate.

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Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Cited by 23 publications

References 22 publications

Out-of-Hospital Triage of Older Adults With Head Injury: A Retrospective Study of the Effect of Adding “Anticoagulation or Antiplatelet Medication Use” as a Criterion

Out-of-Hospital Triage of Older Adults With Head Injury: A Retrospective Study of the Effect of Adding “Anticoagulation or Antiplatelet Medication Use” as a Criterion

Risk of unfavorable long-term outcome in older adults with traumatic intracranial hemorrhage and anticoagulant or antiplatelet use

Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old "horses" are not to be shot!

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