The effects of hematological parameters and anticoagulant/antiaggregant use on surgical outcomes in acute subdural hematoma

Abstract

Objective: This study aims to investigate the effect of hematologic parameters including International Normalized Ratio (INR), platelet (Plt), hemoglobin (Hb), hematocrit (Htc), mean corpuscular volume (MCV), leukocyte, neutrophil, lymphocyte, C-Reactive Protein (CRP) on the outcomes of surgical treatment of acute subdural hematoma.
 Material and Methods: The file data of 31 cases who were operated on with the diagnosis of Acute Subdural Hematoma (ASDH) at the Private Ankara Güven Hospital Neurosurgery Clinic between 01.01.2019 and 31.12.2021 were examined retrospectively. The ages, genders, history of anticoagulant/antiaggregant use, INR, platelet, hemoglobin, hematocrit, leukocyte, and CRP values of patients were recorded, and their relationships with re-bleeding, number of surgeries performed, and mortality were evaluated statistically.
 Results: The study was conducted with a total of 31 cases (35.5% (n=11) female and 64.5% (n=20) male). The average age of the cases was 72 (45-93). A single surgery was performed in 23 cases (74.2%), 8 patients (25.8%) were operated on again because of re-bleeding, and 9 of the cases (29%) died following the surgery. Among the 9 patients who died, 5 (55.5%) underwent single surgery and 4 (44.5%) underwent more than one surgery. The number of cases not using pre-operative anticoagulants/antiaggregants was 10 (32.3%), 9 (29%) patients were using anticoagulants, 7 patients (22.6%) were using single antiaggregant, and 5 patients (16.1%) were using dual antiaggregants. It was detected as statistically significant that the preoperative INR, leukocyte, and neutrophil counts of the patients who underwent multiple surgeries were detected to be higher than those of ASDH patients who underwent single surgery.
 Conclusion: Although pre-operative INR, leukocyte, and neutrophil elevation are not associated with mortality, these parameters can be associated with the requirement for re-surgery because of re-bleeding.
 Key words: re-bleeding, subdural hematoma, mortality, leukocyte, neutrophil