Een retrospectief onderzoek naar oorzaak, behandeling en beloop van hersenbloedingen tijdens orale antistollingsbehandeling

– A retrospective study was made of the fates of the 92 patients admitted to the University Hospital of Leyden in the period 1970-1985 because of a cerebral haemorrhage during oral anticoagulant treatment. All patients were over 50 years of age. Over 75 of them had a history of hypertension.

There was no correlation between occurrence of haemorrhages and duration of anticoagulant treatment. The median intensity of the anticoagulant treatment on admission, however, was distinctly higher than usual.

Treatment varied: no specific treatment, treatment with vitamin K₁, treatment with prothrombin complex concentrate (PCC), surgery and combinations of these.

This retrospective study showed that mortality increased with advancing age and was distinctly correlated with the degree of consciousness: all 32 patients who were comatose on admission died, irrespective of treatment. Also, all patients left untreated died, including the four not in coma. Of the 56 non-comatose treated patients, those given PCC or combinations showed a slightly larger proportion of survival than those given vitamin K₁ or combinations (66 and 56, respectively). The survivors‘ quality of life was not treatment-related.

It is concluded from the findings that reversing the anticoagulation effect in comatose patients is useless. When non-comatose patients are treated at all, the combination of vitamin K₁ and PCC appears to be the most rational choice.