The effects of hematological parameters and anticoagulant/antiaggregant use on surgical outcomes in acute subdural hematoma Effects of Hematological Parameters in Acute Subdural Hematoma
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Abstract
Objective: This study aims to investigate the effect of hematologic parameters including International Normalized Ratio (INR), platelet (Plt), hemoglobin (Hb), hematocrit (Htc), mean corpuscular volume (MCV), leukocyte, neutrophil, lymphocyte, C-Reactive Protein (CRP) on the outcomes of surgical treatment of acute subdural hematoma.
Material and Methods: The file data of 31 cases who were operated on with the diagnosis of Acute Subdural Hematoma (ASDH) at the Private Ankara Güven Hospital Neurosurgery Clinic between 01.01.2019 and 31.12.2021 were examined retrospectively. The ages, genders, history of anticoagulant/antiaggregant use, INR, platelet, hemoglobin, hematocrit, leukocyte, and CRP values of patients were recorded, and their relationships with re-bleeding, number of surgeries performed, and mortality were evaluated statistically.
Results: The study was conducted with a total of 31 cases (35.5% (n=11) female and 64.5% (n=20) male). The average age of the cases was 72 (45-93). A single surgery was performed in 23 cases (74.2%), 8 patients (25.8%) were operated on again because of re-bleeding, and 9 of the cases (29%) died following the surgery. Among the 9 patients who died, 5 (55.5%) underwent single surgery and 4 (44.5%) underwent more than one surgery. The number of cases not using pre-operative anticoagulants/antiaggregants was 10 (32.3%), 9 (29%) patients were using anticoagulants, 7 patients (22.6%) were using single antiaggregant, and 5 patients (16.1%) were using dual antiaggregants. It was detected as statistically significant that the preoperative INR, leukocyte, and neutrophil counts of the patients who underwent multiple surgeries were detected to be higher than those of ASDH patients who underwent single surgery.
Conclusion: Although pre-operative INR, leukocyte, and neutrophil elevation are not associated with mortality, these parameters can be associated with the requirement for re-surgery because of re-bleeding.
Key words: re-bleeding, subdural hematoma, mortality, leukocyte, neutrophil
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2023-09-25
Published 2023-09-27
References
Tuzcu K, Davarcı İ, Hakimoğlu S, et al. Akut ve kronik subdural kanamalı hastalarda nötrofil/lenfosit oranı ve ortalamatrombosit hacminin değerlendirilmesi Med J MKU. 2015; 4(14): 23-30.
Camel M, Grubb RL. Treatment of chronic subdural hematoma by twist-drill craniostomy with continuous catheter drainage. Journal of neurosurgery. 1986;65(2): 183-187.
Kılınçaslan, M, Kaptan H, İlhan M, Kasımcan Ö, Çakıroğlu K, Kılıç C. Travmatik akut subdural hematomlarda prognostik faktörler ve mortaliteye etkileri. Journal of Nervous System Surgery. 2008;1(4): 214-219.
Bullock, MR, Chesnut R, Ghajar J, et al. Surgical management of acute epidural hematomas. Neurosurgery 2006;58: 7-15.
Massaro F, Lanotte M. One hundred and twenty seven cases of acute subdural hematoma. Acta Neurochir (wien) 1996; 138:185-91.
Guha D, Macdonald RL. Perioperative management of anticoagulation. Neurosurgery Clinics 2017;28(2):287-295.
Ducruet AF, Grobelny BT, Zacharia BE, et al. The surgical management of chronic subdural hematoma. Neurosurgical review 2012;35:155-169.
Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 1994;120(11):897–902.
Hart RG, Diener HC, Yang S, et al. Intracranial hemorrhage in atrial fibrillation patients during anticoagulation with warfarin or dabigatran: the RE-LY trial. Stroke 2012;43(6):1511-1517.
Karasu A, Civelek E, Aras Y, et al. Analyses of clinical prognostic factors in operated traumatic acute subdural hematomas. Ulus travma acil cerrahi derg 2010;16(3):233-236.
Şeker İB, Özsoy SD, Koşar İ, Uysal A, Yeşiltaş MA, Haberal İ. Koroner Bypass Hastalarında Preoperatif Hematolojik Parametrelerin Mortalite ve Morbidite ile İlişkisinin Değerlendirilmesi. F.Ü.Sağ.Bil.Tıp.Derg 2020;34(3):255-264.
Özevren H, Hattapoğlu S. Akut subdural hematomlu 106 olgunun retrospektif değerlendirilmesi. Dicle Tıp Dergisi 2018;45(2):173-178.
Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev 2004; 27: 263-266.
van Essen TA, Lingsma HF, Pisica D, et al. Surgery versus conservative treatment for traumatic acute subdural haematoma : a prospective, multicentre, observational, comparative effectiveness study. The lancet neurology 2022;21(7):620-631.
van Essen TA, Lodewijk R, Jan S, et al. Mortality reduction of acute surgery in traumatic acute subdural hematoma since the 19th Century: systematic review and meta-analysis with dramatic effect: is surgery the obvious parachute?Journal of Neurotrauma 2023;40.1-2:22-32.
de Oliveira AJ, Solla DJ, de Oliveira KF. Post-operative neutrophil-to-lymphocyte ratio variation is associated with chronic subdural hematoma recurrence. Neurological Sciences 2022;43(1):427-434.
Obermeier B, Daneman R, Ransohoff RM. Development, maintenance and disruption of the blood-brain barrier. Nat Med 2013;19:1584–1596.
Zheng H, Chen C, Zhang J, Hu Z. Mechanism and therapy of brain edema after intracerebral hemorrhage. Cerebrovasc Dis 2016;42:155–169.
Papayannopoulos V. Neutrophil extracellular traps in immunity and disease. Nat Rev Immunol 2018;18:134–140.
Trotter W. Chronic subdural haemorrhage of traumatic origin, and its relation to pachymeningitis haemorrhagica interna. Br J Surg 1914;2(6):271–291.
Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KL,Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 2017;14(1):1–13.
Sato S, Suzuki J. Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg 1975;43(5):569–578.
von Leden RE, Parker KN, Bates AA, Noble-Haeusslein LJ, Donovan MH. The emerging role of neutrophils as modifiers of recovery after traumatic injury to the developing brain. Exp Neurol 2019;317:144–154.
Clausen F, Lorant T, Lewen A, Hillered L. T lymphocyte trafficking: a novel target for neuroprotection in traumatic brain injury. J Neurotrauma 2007;24:1295–1307.
Sabouri E, Majdi A, Jangjui P, Rahigh AS, Naseri Alavi SA. Neutrophil-to-lymphocyte ratio and traumatic brain Injury: a review study. World Neurosurg 2020;140:142–147.
Chen J, Qu X, Li Z, Zhang D, Hou L. Peak neutrophil-to-lymphocyte ratio correlates with clinical outcomes in patients with severe traumatic brain injury. Neurocrit Care 2019;30:334–339.
Türk O, Yaldız C, Ceylan D. Kronik subdural hematomlar: epidemiyoloji, radyoloji, hematolojik parametreler ve olgularımızın cerrahi sonuçları. Med J MKU 2018;9(35):121-127.
Han W, Meibiao Z, He Z, et al. The effects of antithrombotic drugs on the recurrence and mortality in patients with chronic subdural hematoma: a meta-analysis. Medicine 2019;98:1(e13972).
Çakır A, Karakaya Z, Efgan MG. Varfarin İlişkili İntrakraniyal Kanamalarda Protrombin Kompleks Konsantresi Kullanım Deneyimlerimiz. In: PCC’nin Tedavideki Yeri ve Önemi. Topkapı, Istanbul: Kültür Sanat Basımevi San.ve Tic. Ltd.Şti/ Culture and Arts; 2020:7-9.
Tosetto A, Balduini CL, Cattaneo M, et al. Management of bleeding and of invasive procedures in patients with platelet disorders and/or thrombocytopenia: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res 2009;124:13-18.