Abstract
Objective: To examine whether antithrombotic therapy affects the incidence of postoperative hemorrhage after endoscopic hematoma removal for hypertensive intracerebral hemorrhage (ICH), and whether prothrombin complex concentrate (PCC) is useful in reducing adverse events.
Methods: We retrospectively reviewed 193 patients who underwent endoscopic hematoma removal for ICH between January 2004 and July 2018. Patients with vascular abnormalities, including moyamoya disease and arteriovenous malformation were excluded. Contributing clinical factors of postoperative hemorrhage were analyzed, and the effectiveness of the preoperative use of PCC for patients receiving anticoagulants was evaluated.
Results: Among the 193 patients, 35 were taking antithrombotic agents (18%), including 19 on anticoagulants (warfarin=14, direct oral anticoagulants=5) and 21 taking antiplatelet agents. Postoperatively, 13 patients (6.7%) showed hemorrhage at the surgical site, which was associated with worse clinical outcome. Among the clinical factors analyzed, only anticoagulants showed a statistically significant relationship to postoperative hemorrhage. The effect of antiplatelet agents was not significant. For patients receiving warfarin, vitamin K2 was routinely administered before surgery, and as of 2012, PCC was additionally administered to 9 patients. After the introduction of PCC, no further patients on anticoagulants experienced postoperative hemorrhage.
Conclusion: Patients receiving anticoagulants are at higher risk of postoperative hemorrhage after endoscopic intracerebral hematoma removal, however, the preoperative use of PCC effectively prevented postoperative hemorrhage.
