Date of Web Publication, Dec Acute subdural hematomas (ASDHs) are rarely reported in the literature. . In addition to aspirin, other antiplatelet agents that have grown in popularity in recent years include clopidogrel, abciximab. other types of intracranial hematomas, subdural hematomas (SDHs) are For some patients, a combination of clopidogrel and aspirin is used to maximize the . variables collected prospectively (date of trauma, age, gender, mechanism of. Results 1 - 10 of 29 Evidence-based information on aspirin and subdural haematoma from Does Clopidogrel Increase Morbidity and Mortality After Minor Head.
Aim The aim of the study was to examine the risk of SDH in cirrhotic patients. Design A retrospective study from a universal insurance claims database of Taiwan.
Methods A cohort of liver cirrhotic patients from to and an age-and sex-matched control cohort of subjects without cirrhosis were identified.
The severity of liver cirrhosis was classified into uncomplicated and complicated according to presence of complications or not. The incidence and hazard ratio of SDH were measured by the end of Results The mean follow-up years were 4. The incidence of SDH was 2.
The adjusted hazard ratios were 2. Conclusions This study demonstrates that patients with cirrhosis are at higher risk of both traumatic and non-traumatic SDH than individuals without cirrhosis. The risk increases further in patients with complicated liver cirrhosis. Introduction Subdural hematoma SDH is the most common traumatic brain injury with high fatality rate.
Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation
Clinical presentations of SDH are classified into acute, subacute and chronic. Patients with acute SDH often have a major trauma, most commonly caused by motor vehicle crashes in younger patients and by falls in elderly patients. This population includes those with advancing age, chronic alcohol abuse, and previous traumatic brain injury.
It accounted for approximately 49 deaths in the United States in To assure the accuracy of diagnosis, the Bureau of National Health Insurance sifted and validated medical records. Study participants We identified patients who were 20 years of age or older with newly diagnosed liver cirrhosis ICDCM codes Patient underwent to neuroimaging examination.
CT scan showed bilateral ASDH in fronto-temporo-parietal region more thickness in the left hemisphere, compressive effect on sovratentorial ventricular system and edema [Figure 3]. Neurosurgical operation was delayed for preservation of consciousness state and presence of coagulative deficiency.
The day after INR was 2. Because of consciousness falling, he retried a CT scan that showed an increase of the hematoma. For these reasons he was immediately treated with a neurosurgical operation.
Female patient, year-old, history of cirrhosis Male patient, year-old, history of mitral valve replacement. All conditions resulting in a low platelet count can predispose a patient to ICH. Thrombocytopenia has multiple causes, and one common classification scheme is as follows: Decreased platelet production, as seen in certain congenital disorders and cases of bone marrow damage due to radiation, drugs Increased platelet destruction Abnormal sequestration, usually in the spleen, as in cirrhosis Multiple causes, as commonly seen in alcoholics.
Intracranial hemorrhage cases induced by thrombocytopenia have been linked to use of certain drugs, as well as to uremia, alcohol use, and liver transplants. A large number of abnormalities of hemostasis were demonstrated in alcoholics patients. Thrombocytopenia in these patients is due to associated folate deficiency, splenic sequestration and direct toxic effects of alcohol on the bone marrow. Numerous functional deficits have also been described in the platelets of alcoholics, which are associated with disturbances in ultrastructural morphology.
aspirin and subdural haematoma | Evidence search | NICE
Data results further indicated that the alcohol had a greater effect on ICH that were subarachnoid in origin, conferring a fold increased risk for moderate and heavy drinkers compared with nondrinkers. A lot of drugs have been associated with thrombocytopenia, including certain cytotoxic drugs, antimalarial agents, antiepileptic medications, furosemide, digoxin, and estrogens.
In a review, Hart, et al. Evaluation of individual large series shows great variation in the incidence of anticoagulation-treated patients in whom ICH is a complication, with annual incidences ranging from 0.
Aspirin works by irreversibly inactivating the enzyme cyclooxygenase, which results in decreased production of the natural platelet aggregate thromboxane A2. Aspirin-related ICH has been studied in detail. The first suggestion that increased incidence of ICH might be a complication in aspirin users is found in Physician's Health Study, which reported 23 hemorrhagic strokes among 11, individuals receiving low-dose aspirin mg every other day compared with 12 hemorrhagic strokes in 11, individuals receiving placebo.
The most comprehensive data are derived from a metaanalysis conducted by Memon et al. Analysis of current data suggests that the newer antiplatelet agents discussed thus seem to be associated with an ICH risk profile similar to that of aspirin.
Warfarin, heparin, and enoxaparin are currently the most commonly used anticoagulants. Warfarin thus prolongs the PT and is monitored by assessing a standardized form of this test known as the INR. Heparin, on the other hand, is a parenterally administered anticoagulant agent that acts by potentiating the action of both antithrombin III and tissue factor pathway inhibitor TFPIthus prolonging the PTT. It is obtained by alkaline degradation of heparin benzyl ester and is approximately one third the molecular size of standard heparin.
The mechanism of action of enoxaparin is similar to that of heparin, although enoxaparin has a longer half-life 4. Blood coagulation and platelet-mediated hemostasis are the two important defense mechanisms against bleeding. Anticoagulant mechanisms ensure careful control of coagulation and under normal conditions, prevail over the procoagulant forces.
- Association of Antithrombotic Drug Use With Subdural Hematoma Risk
In the CNS, however, an imbalance between pro- and anticoagulant systems due to inherited or acquired factors may result in bleeding or thrombotic diseases. Spontaneous ASDH is a nosological entity rare but extremely serious.