Klinische Wochenschrift

, Volume 65, Issue 16, pp 781–790 | Cite as

Intrakranielle und intraspinale Blutungen unter Behandlung mit Cumarinderivaten

Katamnese von 63 Fällen zwischen 1978 und 1986
  • D. Moskopp
  • F. Brassel
  • F. Ries
Originalien
Received:
Revised:
Accepted:

Abkürzungen

CT

Röntgen-Computertomographie

„Cumarine“

für Cumarinderivate; hier zu 97% Phenprocoumon

„ZNS“-Blutung

nur der Kürze wegen fürbegrifflich korrekt: „intrakranielle und intraspinale“ Blutung

Intracranial and intraspinal bleedings in patients under coumarin derivatives

Summary

From 1978–1986, 63 patients (48–79 years) under coumarin derivatives had to be hospitalized neurosurgically because of intrcranial or intraspinal bleedings. This corresponds to a twelvefold increased risk compared to the untreated people. The male/female ratio was 1.5. At the time of the bleeding there was no true indication for anticoagulation in at least 60% of the patients. 80% with coma on admission died. Only for 2/7 with an intraspinal hemorrhage the outcome was better than paraplegic. Women proved to have a better chance of survival. — There is a need for more concise indications for chronic anticoagulation.

Key words

Chronic oral anticoagulation Central nervous system Intracranial hemorrhage Intraspinal hemorrhage Coumarin derivatives 
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    Alderman DB (1956) Extradural spinal-cord hematoma. Report of a case due to dicumarol and review of the literature. New Engl J Med 255:839–842Google Scholar
  2. 2.
    Angstwurm H, Frick E (1967) Nil nocere! Neurologische Komplikationen der Antikoagulantientherapie. MMW 109:1103–1109Google Scholar
  3. 3.
    Aring CD (1952) Neurological clinical pathological conference of the Cincinnati General Hospital. Dis Nerv Syst 13:53–60Google Scholar
  4. 4.
    Askey JM (1966) Hemorrhage during longterm anticoagulant drug therapy. Calif Med 104:6–10Google Scholar
  5. 5.
    Beaumont JL, Tarrit A (1955) Les accidents hémorragiques survenus au cours de 1.500 traitements anticoagulants. Sang 26:680–694Google Scholar
  6. 6.
    Beck R, Stammler A (1983) Spontane und traumatische intrakranielle Blutungen unter Antikoagulantientherapie (Marcumar). In: Seitz D, Vogel P (Hrsg) Verhandlungen der Deutschen Gesellschaft für Neurologie (56. Tagung), Bd 2, Springer, Berlin, pp 559–561Google Scholar
  7. 7.
    Beck EA (1985) Wie können wir die Langzeit-Antikoagulation verbessern? Schweiz Med Wochenschr 115:1495–1500Google Scholar
  8. 8.
    Bewermeyer H, Schumacher A, Neveling M, Heiss WD (1984) Hämorrhagische neurologische Komplikationen bei Therapie mit Antikoagulantien und Fibrinolytika. Dtsch Med Wochenschr 109:1653–1659Google Scholar
  9. 9.
    Comp PC, Esmon CT (1984) Familial protein S deficiency is associated with recurrent thrombosis. J Clin Invest 74:2082–2088Google Scholar
  10. 10.
    Duckert F, Marbet GA (1977) Die Kontrolle der oralen Antikoagulation. Der therapeutische Bereich. Praxis 66:293–294Google Scholar
  11. 11.
    Duckert F (1977) Häufige Fehlerquellen bei der Laborkontrolle der oralen Antikoagulation. Ther Umsch 34:350–354Google Scholar
  12. 12.
    Egeberg O (1965) Inherited antithrombin deficiency causing thrombophilia. Thromb Diath Haemorrh 13:516–530Google Scholar
  13. 13.
    Furlan AJ, Whisnant JP, Elveback LR (1979) The decreasing incidence of primary intracerebral hemorrhage: A population study. Ann Neurol 5:367–373Google Scholar
  14. 14.
    Gaenshirt H, Haack G (1983) Nebenwirkungen der Antikoagulantien am Nervensystem. In: Seitz D, Vogel P (Hrsg) Verhandlungen der Deutchen Gesellschaft für Neurologie (56. Tagung), Bd 2, Springer, Berlin, pp 231–240Google Scholar
  15. 15.
    Gaudel G, Fouchard J (1979) Complications du traitement anticoagulant. A propos de 98 accients et incidents. Sem Hôp Paris 55:1340–1345Google Scholar
  16. 16.
    Griffin JH, Evatt B, Zimmerman TS, Kleiss AJ, Wideman C (1981) Deficiency of protein C in congenital thrombotic disease. J Clin Invest 68:1370–1373Google Scholar
  17. 17.
    Handin RI (1987) Inherited thrombotic disorders and anti-thrombotic therapy. In: Braunwald E, et al. (eds) Harrison's Principles of Internal Medicine, 11e, McGraw-Hill, New York, pp 1480–1483Google Scholar
  18. 18.
    Hellstern P, Koehler M, Wenzel E (1982) Indikation und Durchführung der Antikoagulantientherapie. Therapiewoche 32:2099–2106Google Scholar
  19. 19.
    Hoffmann-La Roche AG (1987) Persönliche Mitteilung, Brief vom 16.02.1987, Grenzach-Wyhlen, Prager/SteffensGoogle Scholar
  20. 20.
    Huguenin P (1967) Das intrakranielle Subduralhämatom unter Antikoagulantienbehandlung. Schweiz Arch Neurol Neurochir Psychiatr 100:38–69Google Scholar
  21. 21.
    Hull R, Hirsch J, Carter C, England C, Gent M, Turpie AGG, McLoughlin D, Dodd P, Thomas M, Raskob G, Ockelford P (1982) Different intensities of oral anticoagulant therapy in the treatment of proximal vein thrombosis. N Engl J Med 307:1676–1681Google Scholar
  22. 22.
    Iizuka J (1972) Intracranial and intraspinal haematomas associated with anticoagulant therapy. Neurochirurgia 1:15–25Google Scholar
  23. 23.
    Kase CS, Robinson RK, Stein RW, DeWitt LD, Hier DB, Harp DL, Williams JP, Caplan LR, Mohr JP (1985) Anticoagulant-related intracerebral hemorrhage. Neurology (Minneap) 35:943–948Google Scholar
  24. 24.
    Klingler M (1966) Intrakranielle Blutungen bei Antikoagulantientherapie. Schweiz Arch Neurol Neurochir Psychiatr 98:20–25Google Scholar
  25. 25.
    Leickert KH (1980) Spezielle Indikationen für Cumarinderivate zur Thromboseprophylaxe. Med Welt 31:1828–1844Google Scholar
  26. 26.
    Lévy A, Stula D (1971) Neurochirurgische Aspekte bei Antikoagulantienblutungen im Zentralnervensystem. Dtsch Med Wochenschr 96:1043–1048Google Scholar
  27. 27.
    Link KP (1944) Anticoagulant from spoiled sweet clover hay. Harvey Lect 39:162–216Google Scholar
  28. 28.
    Loeliger EA (1982) Blutungskomplikationen bei Behandlung mit oralen Antikoagulantien. In: Marx R, Thies HA, Tilsner V (Hrsg) Aktuelle Antikoagulation in Klinik und Praxis. Editiones Roche, 1982, pp 173–178Google Scholar
  29. 29.
    Marder VJ (1984) Molecular bad actors and thrombosis. N Engl J Med 310:588–589Google Scholar
  30. 30.
    Marti P, Beck EA (1983) Standardisierungsprobleme bei der Überwachung der oralen Antikoagulation durch die Thromboplastinzeit nach Quick: Versuch einer Standort-bestimmung für die Schweiz. Schweiz Med Wochenschr 113:1593–1597Google Scholar
  31. 31.
    McKissock W, Richardson W, Taylor J (1961) Primary intracerebral haemorrhage. A controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet ii:221–226Google Scholar
  32. 32.
    Oehler G, Lasch HG (1982) Antithrombotische Therapie. Inn Med 9:401–409Google Scholar
  33. 33.
    O'Reilly RA (1985) Anticoagulant, antithrombotic, and thrombolytic drugs. In: Gilman AG, et al. (eds) Goodman and Gilman's The Pharmacological Basis of Therapeutics, 7e, Macmillan, New York, pp 1338–1359Google Scholar
  34. 34.
    Quick AJ (1959) The development and use of the prothrombin tests. Circulation 19:92–96Google Scholar
  35. 35.
    Ransohoff J, Derby B, Kricheff I (1971) Spontaneous intracerebral hemorrhage. Clin Neurosurg 18:247–266Google Scholar
  36. 36.
    Reinhardt H, Huber E (1983) Intracranial bleedings associated with anticoagulant therapy. Advances in Neurosurgery (Berlin) 11:139–142Google Scholar
  37. 37.
    Roos J, Joost HEv (1965) The cause of bleeding during anticoagulant treatment. Acta Med Scand 178:129–131Google Scholar
  38. 38.
    Schaerer HU, Biland L, Baitsch G, Laffer U (1976) Schwere Blutungen unter Antikoagulation. In: Neuhaus K, Duckert F (Hrsg) Blutgerinnung und Antikoagulation: Aktuelle Probleme für Klinik und Praxis, Schattauer, Stuttgart, pp 19–23Google Scholar
  39. 39.
    Schoendorf H (1974) Blutungskomplikationen am Nervensystem unter Antikoagulantien-Therapie. MMW 116:373–378Google Scholar
  40. 40.
    Schofield FW (1924) Damaged sweet clover: The cause of a new disease in cattle simulating hemorrhagic septicemia and blackleg. J Am Vet Med Assoc 64:553–575Google Scholar
  41. 41.
    Schroll A (1977) Meßmethoden in der Gerinnungsanalytik: Vergleich von Thromboplastinpräparaten. Diagnostik 10:202–206Google Scholar
  42. 42.
    Schwarz HP, Fischer M, Hopmeier P, Batard MA, Griffin JH (1984) Plasma protein S deficiency in familial thrombotic disease. Blood 64:1297–1300Google Scholar
  43. 43.
    Seiler K (1972) Entgleisung der oralen Antikoagulantien. Schweiz Med Wochenschr 102:1415–1423Google Scholar
  44. 44.
    Shields RW, Laureno R, Lachman T, Victor M (1984) Anticoagulant-related hemorrhage in acute cerebral embolism. Stroke 15:426–437Google Scholar
  45. 45.
    Shlevin EL, Lederer M (1944) Uncontrollable hemorrhage after dicoumarol therapy with autopsy findings. Ann Intern Med 21:332–342Google Scholar
  46. 46.
    Silverstein A (1979) Neurological complications of anticoagulant therapy: A neurologist's review. Arch Intern Med 139:217–220Google Scholar
  47. 47.
    Statistisches Bundesamt Wiesbaden (Hrsg) (1986) Statistisches Jahrbuch 1986 für die Bundesrepublik Deutschland. W. Kohlhammer GmbH, Stuttgart & Mainz, 1986, pp 61–63Google Scholar
  48. 48.
    Tarrit A (1955) Les accidents hémorrhagiques du traitement anticoagulant d'après l'analyse de 1.500 traitements. Thèse Médecine, Paris, 80 ppGoogle Scholar
  49. 49.
    The Epsim Research Group (1982) A controlled comparison of aspirin and oral anticoagulant in prevention of death after myocardial infarction. N Engl J Med 307:701–708Google Scholar
  50. 50.
    The Sixty Plus Reinfarction Study Research Group (1980) A double-blind trial to assess long-term oral anticoagulant therapy in elderly patients after myocardial infarction. Lancet ii:989–994Google Scholar
  51. 51.
    The Sixty Plux Reinfarction Study Research Group (1982) Risks of long-term oral anticoagulant therapy in elderly patients after myocardial infarction. Lancet i:64–68Google Scholar
  52. 52.
    Wintzen AR, Tijssen JGP (1982) Subdural hematoma and oral anticoagulant therapy. Arch Neurol 39:69–72Google Scholar
  53. 53.
    Wintzen AR, De Jonge H, Loeliger EA, Bots GTAM (1984) The risk of intracerebral hemorrhage during oral anticoagulant treatment: A population study. Ann Neurol 16:553–558Google Scholar

Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • D. Moskopp
    • 1
  • F. Brassel
    • 2
  • F. Ries
    • 3
  1. 1.Neurochirurgische UniversitätsklinikGermany
  2. 2.Neuroradiologische Abteilung der Neurochirurgischen UniversitätsklinikGermany
  3. 3.Universitäts-Nervenklinik — Neurologie Rheinische-Friedrich-Wilhelms-Universität BonnGermany

Personalised recommendations