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SDH with Bleeding Diathesis—a Management Protocol

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Abstract

Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderly. Patients taking antiplatelets and/or anticoagulants have increased risk of bleeding during the perioperative period. Precise dose blood products and specific surgical technique have been effective in preventing hemorrhagic complications perioperatively. From Jan 2010 to Dec 2012, 25 patients who were on antiplatelets and/or oral anticoagulants underwent emergency surgery for chronic or acute on chronic SDH. Patients were divided into three groups: group I—patients on antiplatelets, group II—patients on oral anticoagulants, and group III—patients taking both. Of these, 21 patients underwent minicraniotomy with microsurgical membranectomy and 4 patients underwent burr hole craniostomy. Random donor platelet concentrate (RDPC) and fresh frozen plasma (FFP) were used depending on whether patient was on antiplatelets or oral anticoagulants. Results were evaluated on the basis of ease of intraoperative hemostasis, incidence of rebleeding in postoperative period, postoperative imaging, and reversal of neurological deficits. Group I, group II, and group III had 16, 4, and 5 patients, respectively. Group I received a mean of 7 units of RDPC. Group II received a mean of 4 units of FFP. Group III received a mean of 7 units of RDPC and 4 units FFPs. There was no problem with intraoperative hemostasis and no incidence of rebleeding. We suggest specific dose protocol for reversal of antiplatelet and anticoagulant effect and specific surgical procedure in preventing intraoperative bleeding and postoperative rebleeding in the above group of patients.

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References

  1. Giorgia DB, Giuseppe L, Antonio D, Fabio P, Vito L, Gianni T, Antonio N (2012) Association of aspirin use with major bleeding in patients with and without diabetes. JAMA 307:2286–2294

    Google Scholar 

  2. Morten LH, Rikke S, Mette TC, Marie L et al (2010) Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med 170:1433–1441

    Google Scholar 

  3. Campbell PG, Yadla S, Sen AN, Jallo J, Jabbour P (2011) Emergency reversal of clopidogrel in the setting of spontaneous intracerebral hemorrhage. World Neurosurg 76:100–104

    Article  PubMed  Google Scholar 

  4. Peter GC, Anish S, Sanjay Y, Pascal J, Jack J (2010) Emergency reversal of antiplatelet agents in patients presenting with an intracranial hemorrhage: a literature review. World Neurosurg 74:279–285

    Article  Google Scholar 

  5. Bernstein MJ (1987) Platelet transfusion theory consensus conference. JAMA 257:1777–1780

    Article  Google Scholar 

  6. Chowdhury P, Saayman A, Paulus U, Findley G, Collins P (2004) Efficacy of standard dose and 30 mL/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. Br J Haematol 125:69–73

    Article  PubMed  Google Scholar 

  7. Müller MC, Arbous MS, Angelique M, Vink R (2015) Transfusion of fresh-frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial. Transfusion 55:26–35

    Article  PubMed  Google Scholar 

  8. Müller et al (2011) Transfusion of fresh frozen plasma in nonbleeding ICU patients -TOPIC TRIAL: study protocol for a randomized controlled trial. Trials 12:266

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ansell J, Hirsh J, Poller L et al (2004) The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126:204S–233S

    Article  CAS  PubMed  Google Scholar 

  10. Lee J-Y, Ebel H, Ernestus RI, Klug N (2004) Various surgical treatments of the chronic subdural hematoma and outcome in 172 patients: is partial membranectomy necessary? Surg Neurol 61:523–528

    Article  PubMed  Google Scholar 

  11. Byung-Soo J-KL, Seo B-R, Sung-Jun M, Jae-Hyoo K, Soo-Han K (2008) Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurg Soc 42:11–15

    Google Scholar 

  12. Fogelholm R, Waltimo O (1975) Epidemiology of chronic subdural hematoma. Acta Neurochir 32:247

    Article  Google Scholar 

  13. Vanderfield GK, Berry G, Dan NG et al (1986) Experience with chronic subdural haematomas in New South Wales. Aust N Z J Surg 56:577

    Article  CAS  PubMed  Google Scholar 

  14. Kudo H, Kuwamura K, Izawa I et al (1992) Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir (Tokyo) 32:207

    Article  CAS  Google Scholar 

  15. Ernestus RI, Beldzinski P, Lanfermann H et al (1997) Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol 48:220

    Article  CAS  PubMed  Google Scholar 

  16. Cameron MM (1978) Chronic subdural haematoma: a review of 114 cases. J Neurol Neurosurg Psychiatry 41:834

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Sato M, Endo Y, Takahagi S et al (1995) Chronic subdural hematoma with bleeding tendency; clinical analysis of 11 surgical cases. No Shinkei Geka 23:49

    CAS  PubMed  Google Scholar 

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The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Neurosurgery, St. John’s Medical College, Sarjapur Road, Bangalore, 560034, India

    Gurneet Singh Sawhney, Manmeet Singh Chhabra, Vineesh K. Varghese, Ashish Tiwari & Ashis K. Chand

  2. Department of Hematology, St. John’s Medical College, Bangalore, India

    Cecil R. Ross

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  1. Gurneet Singh Sawhney
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  2. Cecil R. Ross
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  3. Manmeet Singh Chhabra
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  4. Vineesh K. Varghese
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  5. Ashish Tiwari
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  6. Ashis K. Chand
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Correspondence to Gurneet Singh Sawhney.

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Sawhney, G.S., Ross, C.R., Chhabra, M.S. et al. SDH with Bleeding Diathesis—a Management Protocol. Indian J Surg 78, 121–124 (2016). https://doi.org/10.1007/s12262-015-1331-7

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  • DOI: https://doi.org/10.1007/s12262-015-1331-7

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