Surgery for Coagulopathy-Related Intracerebral Hemorrhage: Craniotomy vs. Minimally Invasive Neurosurgery.

Yen-Bo Liu,Dar-Ming Lai,Woon-Man Kung,Chih-Hao Chen,Sheng-Chieh Chou,Lu-Ting Kuo,Shih-Hung Yang,Hsin-Hsi Tsai,Kuo-Chuan Wang,Abel Po-Hao Huang

doi:10.3390/life11060564

Yen-Bo Liu, Dar-Ming Lai + Show 8 more

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https://doi.org/10.3390/life11060564

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Abstract

Coagulopathy-related intracerebral hemorrhage (ICH) is life-threatening. Recent studies have shown promising results with minimally invasive neurosurgery (MIN) in the reduction of mortality and improvement of functional outcomes, but no published data have recorded the safety and efficacy of MIN for coagulopathy-related ICH. Seventy-five coagulopathy-related ICH patients were retrospectively reviewed to compare the surgical outcomes between craniotomy (n = 52) and MIN (n = 23). Postoperative rebleeding rates, morbidity rates, and mortality at 1 month were analyzed. Postoperative Glasgow Outcome Scale Extended (GOSE) and modified Rankin Scale (mRS) scores at 1 year were assessed for functional outcomes. Morbidity, mortality, and rebleeding rates were all lower in the MIN group than the craniotomy group (8.70% vs. 30.77%, 8.70% vs. 19.23%, and 4.35% vs. 23.08%, respectively). The 1-year GOSE score was significantly higher in the MIN group than the craniotomy group (3.96 ± 1.55 vs. 3.10 ± 1.59, p = 0.027). Multivariable logistic regression analysis also revealed that MIN contributed to improved GOSE (estimate: 0.99650, p = 0.0148) and mRS scores (estimate: −0.72849, p = 0.0427) at 1 year. MIN, with low complication rates and improved long-term functional outcome, is feasible and favorable for coagulopathy-related ICH. This promising result should be validated in a large-scale prospective study.

Highlights

A significant increase worldwide in patients with coagulopathy-related intracerebral hemorrhage (ICH) has been observed due to the increased use of antithrombotic agents over the last decade for the prevention of cardioembolic events, coronary heart disease, and thrombotic-related disease [1,2]
The use of vitamin K antagonists (VKAs) has been associated with ICH rates of up to 1.8% per annum, while ICH rates among novel oral anticoagulant (NOAC)-treated patients are 40–70% lower than that with warfarin [5]; of particular concern is the finding that Asians are four times more likely than Caucasians to develop VKArelated ICH [6]
ICH patients on hemodialysis are exposed to a latent activation of coagulation resulting in an elevated thrombogenic risk, which has been associated with an increased mortality rate ranging from 43.8 to 83% [9,10,11,12]

Summary

Introduction

A significant increase worldwide in patients with coagulopathy-related intracerebral hemorrhage (ICH) has been observed due to the increased use of antithrombotic agents over the last decade for the prevention of cardioembolic events, coronary heart disease, and thrombotic-related disease [1,2]. It is estimated that 10–13% and 27–30% of ICH patients who underwent surgery were on the treatment of anticoagulant agents and antiplatelet agents, respectively [3,4]. The use of vitamin K antagonists (VKAs) has been associated with ICH rates of up to 1.8% per annum, while ICH rates among novel oral anticoagulant (NOAC)-treated patients are 40–70% lower than that with warfarin [5]; of particular concern is the finding that Asians are four times more likely than Caucasians to develop VKArelated ICH [6]. ICH patients on hemodialysis are exposed to a latent activation of coagulation resulting in an elevated thrombogenic risk, which has been associated with an increased mortality rate ranging from 43.8 to 83% [9,10,11,12]

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