J Neurol Surg A Cent Eur Neurosurg 2016; 77(01): 031-035
DOI: 10.1055/s-0035-1558407
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Subdural Hematoma and Oral Anticoagulation: A Therapeutic Dilemma from the Neurosurgical Point of View

M. Javad Mirzayan
1   Department of Neurosurgery, Medical University Hannover, Hannover, Germany
Karoline Calvelli
1   Department of Neurosurgery, Medical University Hannover, Hannover, Germany
Hans-Holger Capelle
1   Department of Neurosurgery, Medical University Hannover, Hannover, Germany
Jessica Weigand
1   Department of Neurosurgery, Medical University Hannover, Hannover, Germany
Joachim K. Krauss
1   Department of Neurosurgery, Medical University Hannover, Hannover, Germany
› Author Affiliations
Further Information

Publication History

02 December 2014

31 March 2015

Publication Date:
20 August 2015 (online)


Background Oral anticoagulation is a common prophylactic therapy for several diseases with a high thromboembolic risk. Such medication harbors a possible hemorrhage risk, with a special risk for subdural hematoma (SDH). The safety and efficacy of resumption of oral anticoagulation versus long-term discontinuation has not been fully clarified in patients who experienced SDH while under treatment with oral anticoagulation.

Material and Methods We investigated the outcome of 49 patients who were identified retrospectively to have a SDH while receiving oral anticoagulation.

Results Most bleeding occurred while patients were within the recommended therapeutic window for oral anticoagulation. Mortality was 15%. The event-free survival probability was higher in the group of patients with reinstitution of phenprocoumon therapy than in the group without. Over a median follow-up of 32 months, thromboembolic events occurred in 4 of 23 patients without oral anticoagulation versus in none of 15 patients with phenprocoumon; hemorrhagic complications occurred in 1 in 23 versus 3 in 15 patients.

Conclusions Reinstitution of oral anticoagulation with phenprocoumon after previous SDH appears to have an acceptable risk for hemorrhagic complications. Decision making might consider case-by-case differences. To establish specific guidelines, prospective large cohort studies are needed.

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