Microsurgical Evacuation Efficacy and Functional Outcomes in Spontaneous Intracerebral Hemorrhage by Type of Antithrombotic Therapy.
Evidence on how different antithrombotic therapies influence microsurgical evacuation efficacy in spontaneous intracerebral hemorrhage (ICH) is limited. Antithrombotic agents may increase hematoma volume and impact postoperative outcomes, complicating surgical management. As growing evidence supports surgical ICH evacuation, understanding the role of antithrombotics and emergency reversal strategies is critical. The aim of this study was a comparative overview on how common types of antithrombotic therapy influence radiographic and clinical outcomes in surgically treated ICH.
In this retrospective study, we included consecutive patients who underwent microsurgical hematoma evacuation for supratentorial ICH between 2008 and 2022. Patient characteristics, antithrombotic therapy, reversal strategies, neuroimaging, and 12-month functional outcome (modified Rankin Scale) were reviewed. Preoperative antiplatelet therapy (APT), vitamin K antagonists, direct oral anticoagulants, and combined antiplatelet/anticoagulant therapy (Comb) was compared with no antithrombotic medication. Multivariable regression models were used to analyze the association between antithrombotic therapy, radiographic, and clinical outcomes.
Overall, we included 232 patients with supratentorial ICH (APT: 53, vitamin K antagonists: 29, direct oral anticoagulant: 13, Comb: 17). Patients with any type of antithrombotic therapy presented with larger absolute preoperative hematoma volumes than patients without prior antithrombotic medication. Combined antiplatelet/anticoagulant therapy affected preoperative ICH volume to the greatest extent (volume difference: 14.9 mL; 95% CI: 0.9, 29.0). APT was associated with a 1.4-fold increase in relative postoperative ICH volume (95% CI: 0.9, 2.1), while combined therapy was associated with a 2.1-fold increase (95% CI: 1.1, 4.0). Unfavorable outcome (modified Rankin Scale ≥4) affected 73.5% of patients and was linked to larger preoperative hematomas (63 mL vs 49 mL) and higher relative postoperative hematoma volume (13.7% vs 7.5%).
Despite preoperative emergency reversal, antithrombotics contributed to higher hematoma volumes, poorer microsurgical evacuation efficacy and worse functional outcome. Particularly for patients receiving APT, the findings underline the importance of optimizing antithrombotic reversal strategies.
In this retrospective study, we included consecutive patients who underwent microsurgical hematoma evacuation for supratentorial ICH between 2008 and 2022. Patient characteristics, antithrombotic therapy, reversal strategies, neuroimaging, and 12-month functional outcome (modified Rankin Scale) were reviewed. Preoperative antiplatelet therapy (APT), vitamin K antagonists, direct oral anticoagulants, and combined antiplatelet/anticoagulant therapy (Comb) was compared with no antithrombotic medication. Multivariable regression models were used to analyze the association between antithrombotic therapy, radiographic, and clinical outcomes.
Overall, we included 232 patients with supratentorial ICH (APT: 53, vitamin K antagonists: 29, direct oral anticoagulant: 13, Comb: 17). Patients with any type of antithrombotic therapy presented with larger absolute preoperative hematoma volumes than patients without prior antithrombotic medication. Combined antiplatelet/anticoagulant therapy affected preoperative ICH volume to the greatest extent (volume difference: 14.9 mL; 95% CI: 0.9, 29.0). APT was associated with a 1.4-fold increase in relative postoperative ICH volume (95% CI: 0.9, 2.1), while combined therapy was associated with a 2.1-fold increase (95% CI: 1.1, 4.0). Unfavorable outcome (modified Rankin Scale ≥4) affected 73.5% of patients and was linked to larger preoperative hematomas (63 mL vs 49 mL) and higher relative postoperative hematoma volume (13.7% vs 7.5%).
Despite preoperative emergency reversal, antithrombotics contributed to higher hematoma volumes, poorer microsurgical evacuation efficacy and worse functional outcome. Particularly for patients receiving APT, the findings underline the importance of optimizing antithrombotic reversal strategies.
Authors
Ferdowssian Ferdowssian, Aigner Aigner, Raff Raff, Schubert Schubert, König König, Koscielny Koscielny, Wasilewski Wasilewski, Wessels Wessels, Vajkoczy Vajkoczy, Hecht Hecht
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