SUBDURAL HEMATOMA AND ANTICOAGULANT THERAPY

  • 1 January 1976
    • journal article
    • research article
    • Vol. 22  (6) , 603-620
Abstract
A series of 22 cases of subdural hematomas in patients submitted to anticoagulant therapy was presented. Subdural hematomas occur in about 1/3 of the patients presenting CNS hemorrage related to anticoagulant therapy. Among subdural hematomas of any cause, the possible role of a previous anticoagulant therapy was stressed in 4.8-14% of the cases. In most cases, long term anticoagulants were indicated for arterial or heart (ischemic) lesions (16/22 cases). In 6 cases, anticoagulants were indicated for prevention or treatment of pulmonary embolies. In 18 cases, anticoagulant drug was from the dicoumarol or phenylindanedione group. In 3 cases, the only anticoagulant given to the patient was heparin. Pathogenic study suggests that hypocoagulability might not always be the only factor of bleeding; high blood pressure, other drugs and head trauma (10 cases) were often associated. Clinical features in this series were similar to those encountered in cases of subdural hematoma of any cause. According to the existence of a cranial injury and to the chronology of anticoagulant therapy, the 22 patients were divided into 3 groups. The use of protamine sulfate or human plasma fraction PPSB [plasma coagulation fractions] provided normal coagulability in a few minutes. Neurosurgical treatment in all cases evaluated a chronic subdural hematoma in 11 patients, an acute in 2 cases and a subacute hematoma in 9 cases. Results were fair in 19 patients with no sequelae; 3 patients died during the immediate post-operative period. Several preventive measures were stressed.