Emergency surgery is an effective way to improve the outcome of severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy

Wu, Jun; Li, Qingyuan; Wang, Kaiwen; Yang, Junhua; Jiang, Pengjun; Li, Maogui; Wang, Nuochuan; Cao, Yong; Ren, Zeguang; Zhang, Yanan; Wang, Shuo

doi:10.1007/s10143-020-01319-x

Cited by 16 publications

(16 citation statements)

References 30 publications

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“…Two or three experienced neurosurgeons jointly decided on the surgical plan and performed the operation. The selection of surgical methods has been described in our previous reports (Wu et al, 2020), and the surgical indications included supratentorial hematoma greater than 30 ml, subtentorial hematoma greater than 10 ml, midline displacement larger than 1 cm, and brain herniation. In addition, APT before the onset of ICH was not considered an absolute contraindication to surgery.…”

Section: Surgerymentioning

confidence: 99%

“…According to reports (Cordonnier et al, 2018;Luzzi et al, 2019), the mortality rate of ICH can be as high as 50%. Although there is no specific treatment for ICH patients, emergency surgery may reduce the mortality rate of ICH patients (Wu et al, 2020). Surgical methods mainly include craniectomy with hematoma evacuation, endoscopic surgery, minimally invasive puncture, and thrombolysis (Luzzi et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Surgical methods mainly include craniectomy with hematoma evacuation, endoscopic surgery, minimally invasive puncture, and thrombolysis (Luzzi et al, 2019). These procedures can effectively reduce the intracranial pressure and hematoma volume of ICH patients (Luzzi et al, 2019;Wu et al, 2020). However, surviving ICH patients may be at risk of postoperative complications, especially postoperative rehemorrhage, which may seriously affect the prognosis of patients (Yu et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Preoperative Antiplatelet Therapy on Early Postoperative Rehemorrhage and Outcomes in Patients With Spontaneous Intracranial Hematoma

Yang

et al. 2021

Front. Aging Neurosci.

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Background and PurposeThe effect of antiplatelet therapy (APT) on early postoperative rehemorrhage and outcomes of patients with spontaneous intracerebral hemorrhage (ICH) is still unclear. This study is to evaluate the effect of preoperative APT on early postoperative rehemorrhage and outcomes in ICH patients.MethodsThis was a multicenter cohort study. ICH patients undergoing surgery were divided into APT group and no antiplatelet therapy (nAPT) group according to whether patients received APT or not. Chi-square test, t-test, and Mann–Whitney U test were used to compare the differences in variables, postoperative rehematoma, and outcomes between groups. Multivariate logistics regression analysis was used to correct for confounding variables, which were different in group comparison.ResultsOne hundred fifty ICH patients undergoing surgical treatment were consecutively included in this study. Thirty five (23.33%) people were included in the APT group, while 115 (76.67%) people were included in the nAPT group. The incidence of early postoperative rehemorrhage in the APT group was significantly higher than that in the nAPT group (25.7% VS 10.4%, p = 0.047 < 0.05). After adjustment for age, ischemic stroke history, and ventricular hematoma, preoperative APT had no significant effect on early postoperative rehemorrhage (p = 0.067). There was no statistical difference between the two groups in early poorer outcomes (p = 0.222) at 14 days after surgery. After adjustment for age, ischemic stroke history, and ventricular hematoma, preoperative APT also had no significant effect on early poorer modified Rankin Scale (mRS) (p = 0.072).ConclusionIn conclusion, preoperative APT appears to be safe and have no significant effect on early postoperative rehematoma and outcomes in ICH patients.

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Section: Surgerymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Preoperative Antiplatelet Therapy on Early Postoperative Rehemorrhage and Outcomes in Patients With Spontaneous Intracranial Hematoma

Yang

et al. 2021

Front. Aging Neurosci.

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“…Although the incidence of cerebral hemorrhage has decreased in the United States in recent years, it has signi cantly increased in developing and low-income countries, including China [2] , Strokes that include cerebral hemorrhage brings a huge pressure on people and their families and societies [3] .Which has resulted in extremely heavy economic burden to individuals [4] . The primary treatment approach for intracerebral hemorrhage is surgery, which can signi cantly improve the prognosis of patients undergoing long-term oral antiplatelet therapy for intracerebral hemorrhage [5] .Surgical treatment is an important treatment for cerebral hemorrhage. Early and timely surgery can improve the prognosis of patients with cerebral hemorrhage and prevent the occurrence of secondary injuries [6] .…”

Section: Introductionmentioning

confidence: 99%

Serum Uric Acid and Calcium Levels as Predictors of Hematoma Volume in Emergency Patients Experiencing Spontaneous Intracerebral Hemorrhage

Zhang

Ding

2021

Preprint

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Objective: To investigate the relationship between serum uric acid and calcium levels and hematoma volume in emergency patients who experienced spontaneous intracerebral hemorrhage (SICH).Methods: Data from 105 patients who experienced SICH and 92 with non-intracerebral hemorrhage (control group) were retrospectively analyzed. Data collected included clinical characteristics, and serum biochemical and blood coagulation indices. Hematoma volume was calculated using computed tomography (CT) imaging data.Results: Individuals who experienced SICH exhibited higher serum uric acid levels and longer activated partial thromboplastin and thrombin times compared to those with non-intracerebral hemorrhage (all P < 0.05). In contrast, serum calcium levels in patients with SICH were lower than those of the control group (P < 0.05). Hypocalcemic patients exhibited a greater median baseline hematoma volume than normocalcemic patients. Conclusion: High serum uric acid and low calcium levels may be predictors of larger hematoma volumes among individuals who experience SICH.

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“…As the population ages, the number of spontaneous intracerebral hemorrhage with long-term oral antiplatelet therapy patients continues to increase [1] . In such patients, many people miss the optimal timing of surgery due to the high risk of postoperative bleeding complication [2] , even though emergency surgery is an effective way to reduce mortality [3] , [4] , [5] , [6] . On the other hand, some studies have shown that non-selective platelet transfusion not only couldn't improve outcome, but also increase ischemic events [7] , [8] , [9] .…”

Section: Introductionmentioning

confidence: 99%

The role of monitoring platelet function perioperatively and platelet transfusion for operated spontaneous intracerebral hemorrhage patients with long-term oral antiplatelet therapy: A case report

Wang

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Spontaneous intracerebral hemorrhage (SICH) with long-term oral antiplatelet therapy (LOAPT) is known as a dilemma in balancing the risk of postoperative rebleeding and ischemic events because of confused coagulation function. We herein describe a report of perioperative management of spontaneous intracerebral hemorrhage patient on long-term oral antiplatelet therapy. Case presentation A 42-year-old male patient on long-term oral antiplatelet therapy presented with coma, and he was diagnosed with spontaneous intracerebral hemorrhage. Considering the patient's clinical condition, despite the thromboelastography suggested that the inhibition of platelet function was high preoperatively, an emergency craniectomy were underwent. After platelet transfusion during surgery and taking control of the clotting and platelet function postoperatively, the patient was stable without rebleeding and new ischemic events in perioperative period and recovered satisfactorily. Clinical discussion Rare studies have provided evidence for managing operated spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy, and whether platelet transfusion is recommended was controversial. In this case, we presented monitoring and taking control of clotting and platelet function postoperatively would help in preventing rebleeding and ischemic events in such patients; moreover, platelet transfusion may quickly and safely reverse platelet dysfunction for emergency surgery. This case was the first to report platelet function and coagulation function management in spontaneous intracerebral hemorrhage patients with long-term oral antiplatelet therapy. Conclusion Monitoring and maintaining coagulation and platelet function perioperatively are essential to balance the risk of postoperative rebleeding and ischemic events.

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Emergency surgery is an effective way to improve the outcome of severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy

Cited by 16 publications

References 30 publications

The Effect of Preoperative Antiplatelet Therapy on Early Postoperative Rehemorrhage and Outcomes in Patients With Spontaneous Intracranial Hematoma

The Effect of Preoperative Antiplatelet Therapy on Early Postoperative Rehemorrhage and Outcomes in Patients With Spontaneous Intracranial Hematoma

Serum Uric Acid and Calcium Levels as Predictors of Hematoma Volume in Emergency Patients Experiencing Spontaneous Intracerebral Hemorrhage

The role of monitoring platelet function perioperatively and platelet transfusion for operated spontaneous intracerebral hemorrhage patients with long-term oral antiplatelet therapy: A case report

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