Abstract
ObjectiveThe correlation of depleted blood through midline shift in acute subdural hematoma remains the most reliable clinical predictor to date. On the other hand, patient’s ABO blood type has a profound impact on coagulation and hemostasis. We conducted this study to evaluate the role of patient’s blood type in terms of incidence, clinical course and outcome after acute subdural hematoma bleeding.Methods100 patients with acute subdural hematoma treated between 2010 and 2015 at the author’s institution were included. Baseline characteristics and clinical findings including Glasgow coma scale, Glasgow outcome scale, hematoma volume, rebleeding, midline shift, postoperative seizures and the presence of anticoagulation were analyzed for their association with ABO blood type.ResultsPatient’s with blood type O were found to have a lower midline shift (p<0.01) and significantly less seizures (OR: 0.43; p<0.05) compared to non-O patients. Furthermore, patients with blood type A had the a significantly higher midline shift (p<0.05) and a significantly increased risk for postoperative seizures (OR: 4.01; p<0.001). There was no difference in ABO blood type distribution between acute subdural hematoma patients and the average population.ConclusionThe ABO blood type has significant influence on acute subdural hematoma sequelae. Patient’s with blood type O benefit in their clinical course after acute subdural hematoma whereas blood type A patients are at highest risk for increased midline shift and postoperative seizures. Further studies elucidating the biological mechanisms of blood type depended hemostaseology and its role in acute subdural hematoma are required for the development of an appropriate intervention.
Highlights
There was no difference in ABO blood type distribution between acute subdural hematoma patients and the average population
Further studies elucidating the biological mechanisms of blood type depended hemostaseology and its role in acute subdural hematoma are required for the development of an appropriate intervention
The blood type O is a result of an inactive glycosyltransferase and is strongly associated with a reduction of the circulating procoagulatory vWF and F VIII (Factor VIII) plasma level of up to 30% compared to non-O blood type. [11]
Summary
Isolated acute subdural hematoma (aSDH) is a form of intracranial bleeding defined by the presence of a blood collection between the dura and arachnoid layer, that requires immediate intensive treatment and the mortality rates are as high as 50–80%. [1] [2] Despite the presence of several outcome prediction models that are based on clinical parameters such as the initial Glasgow coma scale (GCS), present anticoagulation therapy, pupillary status and the time between onset and operation, the prediction of patient’s outcome remains challenging. [3] [4] [5] [6] Midline-shift on the other hand is an established parameter that is associated with a higher frequency of unfavourable outcome and death. [7] [8] additional risk factors are required for the prediction of short and long-term prognosis in these patients. In recent years several studies described the profound influence of the ABO blood type system on patients haemostasis and thrombosis. [9,10] The ABO blood type is determined by the glycosyltransferase on chromosome 9 that attaches monosaccharaides to the cell membrane on erythrocytes, platelets and vascular endothelial cells. A decreased plasma level of vWF and F VIII in patients with blood type O is of direct clinical significance. [13][14] Coherent clinical studies confirmed the blood type O as a bleeding risk factor in several disciplines. [16,17] The influence of patients ABO blood type on clinical course and outcome after aSDH has not been investigated yet. We conducted this study to explore the role of patients ABO blood type as a new risk/prognostic factor
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