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Putaminal Hemorrhage in Patients with Oral Anticoagulants: Course of Treatment and Results of Endoscopic Evacuation

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Treatment of Non-vitamin K Antagonist Oral Anticoagulants

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Abstract

With the aging of the population, the use of oral anticoagulants (ACs) has been increasing. Intracerebral hemorrhage (ICH) is a potentially fatal complication during use of ACs. Surgical evacuation of hematoma located in the deep cerebrum is controversial, but with the continued evolution of endoscopy, surgical evacuation of putaminal hemorrhage is becoming safer and less invasive.

Methods: We retrospectively reviewed the medical records of all cases of AC-related ICH treated at Kawasaki Medical School Hospital during the 10-year period from 2004 to 2015.

Result: A total of 1100 cases of spontaneous ICH were treated at our institution during the study period, with 9.7 % (107 cases) related to oral ACs. We identified 359 patients with putaminal hemorrhage, of whom 7.0 % (25 patients) showed AC-related ICH. Surgical evacuation was considered contraindicated for 20 patients with AC-related putaminal hemorrhage due to insufficient or excessive hematoma volume. Surgical evacuation was performed for five cases, including two cases with expanding hematoma. In the most recent 3 years, we performed endoscopic evacuation for 32 patients with putaminal hemorrhage, including 5AC-related cases. Patients on ACs were older and showed a larger volume of hematoma. In AC-related ICH, hematoma growth was seen twice as often as in ICH unrelated to AC. The evacuation rate of hematoma was over 95 % for both types, with no rebleeding in any cases. The rate of poor outcomes (modified Rankin scale score, 5–6) at 3 months was 40 % (2/5) for AC-related ICH and 31.25 % (10/32) for ICH unrelated to ACs.

Conclusion: Even under oral anticoagulation, with suitable reversal of coagulability, endoscopic evacuation could be performed safely.

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Authors and Affiliations

  1. Department of Neurosurgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan

    Nobuhisa Matsushita M.D., Ph.D. & Masaaki Uno M.D., Ph.D.

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  1. Nobuhisa Matsushita M.D., Ph.D.
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  2. Masaaki Uno M.D., Ph.D.
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Correspondence to Nobuhisa Matsushita M.D., Ph.D. .

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Editors and Affiliations

  1. Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japan

    Masaaki Uno

  2. Department of Neurosurgery, Iwate Medical University, Morioka, Japan

    Kuniaki Ogasawara

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Matsushita, N., Uno, M. (2017). Putaminal Hemorrhage in Patients with Oral Anticoagulants: Course of Treatment and Results of Endoscopic Evacuation. In: Uno, M., Ogasawara, K. (eds) Treatment of Non-vitamin K Antagonist Oral Anticoagulants. Springer, Singapore. https://doi.org/10.1007/978-981-10-1878-7_8

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  • DOI: https://doi.org/10.1007/978-981-10-1878-7_8

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  • Online ISBN: 978-981-10-1878-7

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