Recurrent, Delayed Hemorrhage Associated with Edoxaban after Deep Brain Stimulation Lead Placement

Sivakumar, Walavan; Garber, Sarah T.; Schrock, Lauren E.; House, Paul

doi:10.1155/2013/691840

Cited by 3 publications

(4 citation statements)

References 13 publications

(19 reference statements)

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“…Another study showed that postoperative prophylaxis with or without subcutaneous heparin for venous thromboembolism did not increase the risk for intracranial hemorrhage significantly [ 5 ]. More detailed analysis of the handling of chronic anticoagulation treatment in patients undergoing DBS or with existing DBS systems has been provided mainly in the form of case report or small case series [ 4 , 25 , 31 , 33 , 39 ]. We have reported previously on a patient who received bilateral pallidal DBS for severe chorea due to antiphospholipid antibody syndrome with a need for chronic phenprocoumon treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Intracranial hemorrhage in patients with DBS and subsequent anticoagulation therapy was reported very rarely. In one patient, high-dose intravenous heparin was administered on the first postoperative day for acute myocardial infarction [ 25 ], and in two other patients, edoxaban was restarted already on day 5 and day 7 after surgery [ 20 , 33 ]. One of these patients also had a recurrent hemorrhage later.…”

Section: Discussionmentioning

confidence: 99%

“…The question, however, arises whether an established therapy such as DBS can be denied to these groups of patients. While many neurosurgeons worldwide perform DBS in patients with chronic antiplatelet or anticoagulation treatment, there is very limited published data addressing this problem [ 4 , 25 , 31 , 33 , 36 ]. Furthermore, there are different drugs for antiplatelet or anticoagulation treatment, each with distinctive mechanisms and duration of action.…”

Section: Introductionmentioning

confidence: 99%

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Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment

et al. 2021

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Background In the aging society, many patients with movement disorders, pain syndromes, or psychiatric disorders who are candidates for deep brain stimulation (DBS) surgery suffer also from cardiovascular co-morbidities that require chronic antiplatelet or anticoagulation treatment. Because of a presumed increased risk of intracranial hemorrhage during or after surgery and limited knowledge about perioperative management, chronic antiplatelet or anticoagulation treatment often has been considered a relative contraindication for DBS. Here, we evaluate whether or not there is an increased risk for intracranial hemorrhage or thromboembolic complications in patients on chronic treatment (paused for surgery or bridged with subcutaneous heparin) as compared to those without. Methods Out of a series of 465 patients undergoing functional stereotactic neurosurgery, 34 patients were identified who were on chronic treatment before and after receiving DBS. In patients with antiplatelet treatment, medication was stopped in the perioperative period. In patients with vitamin K antagonists or novel oral anticoagulants (NOACs), heparin was used for bridging. All patients had postoperative stereotactic CT scans, and were followed up for 1 year after surgery. Results In patients on chronic antiplatelet or anticoagulation treatment, intracranial hemorrhage occurred in 2/34 (5.9%) DBS surgeries, whereas the rate of intracranial hemorrhage was 15/431 (3.5%) in those without, which was statistically not significant. Implantable pulse generator pocket hematomas were seen in 2/34 (5.9%) surgeries in patients on chronic treatment and in 4/426 (0.9%) without. There were only 2 instances of thromboembolic complications which both occurred in patients without chronic treatment. There were no hemorrhagic complications during follow-up for 1 year. Conclusions DBS surgery in patients on chronic antiplatelet or anticoagulation treatment is feasible. Also, there was no increased risk of hemorrhage in the first year of follow-up after DBS surgery. Appropriate patient selection and standardized perioperative management are necessary to reduce the risk of intracranial hemorrhage and thromboembolic complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment

et al. 2021

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“…Risk factors of hemorrhage occurrence can be classified into surgical-and patient-related ones. Surgical-related risk factors include the use of multiple recording microelectrodes or multiple attempts to position the definitive electrode, [6] whereas patient-related risk factors include hypertension, [7] antithrombotic therapy, [8] or advanced age. [9] In this paper, we report a patient with acute hydrocephalus due to intraventricular hemorrhage after DBS procedure.…”

Section: Introductionmentioning

confidence: 99%

Hydrocephalus after deep brain stimulation for Parkinson's disease

2019

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A fearsome complication of deep brain stimulation (DBS) constitutes intracranial hemorrhage. Incidence rates vary between 0.5% and 5%, with 1.1% of cases resulting in permanent deficit or death. Intracranial hemorrhage can present asymptomatically or result in fatal outcome. A rare complication in this setting is acute hydrocephalus due to obstruction of the cerebrospinal fluid flow. This complication might have catastrophic consequences resulting in death in a few hours if not an external ventricular drainage promptly is placed. We report a patient with acute hydrocephalus due to intraventricular hemorrhage after the DBS procedure. Patients should be warned of this complication when informed consent is obtained.

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Craniotomy for subdural hematoma after deep brain stimulation surgery: Outcomes and satisfaction in a case series of two patients

Mao

Gigliotti

Angle

et al. 2018

Clinical Neurology and Neurosurgery

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Recurrent, Delayed Hemorrhage Associated with Edoxaban after Deep Brain Stimulation Lead Placement

Cited by 3 publications

References 13 publications

Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment

Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment

Hydrocephalus after deep brain stimulation for Parkinson's disease

Craniotomy for subdural hematoma after deep brain stimulation surgery: Outcomes and satisfaction in a case series of two patients

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