We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Intracranial hemorrhage associated with direct oral anticoagulant after clipping for an unruptured cerebral aneurysm: A report of two cases.
- Authors
Takahiro Koji; Yoshitaka Kubo; Yoshiyasu Matsumoto; Yosuke Akamatsu; Kohei Chida; Hiroshi Kashimura; Kuniaki Ogasawara
- Abstract
Background: Two cases of patients who developed intracranial hemorrhage associated with direct oral anticoagulant (DOAC) use after clipping of an unruptured cerebral aneurysm (uAN) are presented. These cases will help neurosurgeons assess the risks of patients with atrial fibrillation or deep venous thrombosis receiving DOACs who require craniotomy. Case Description: Case 1 was a 65-year-old man on apixaban 10 mg/day who underwent clipping for a left middle cerebral artery uAN. Apixaban was discontinued 72 h before surgery. During surgery, a thin and pial artery bled slightly at 1 point of the frontal lobe, and hemostasis was easily achieved. Computed tomography (CT) 19 h after surgery showed no evidence of intracranial hemorrhage. He was treated with a heparin-apixaban bridge from 29 h to 41 h after surgery. CT showed a left subarachnoid hematoma 24 h later. Case 2 was a 73-year-old woman on dabigatran 110 mg/day who underwent clipping for a right MCA uAN. Dabigatran was discontinued 48 h before surgery. During surgery, a thin and pial artery bled slightly at 2 points of the temporal lobe, and hemostasis was easily achieved. CT 19 h after surgery showed no evidence of intracranial hemorrhage. Dabigatran (110 mg/day) was restarted 29 h after surgery. CT then showed a right subarachnoid hematoma 94 h later, and dabigatran was discontinued, and it was then restarted 38 h later. However, 31 h later, CT showed an additional slight subarachnoid hemorrhage. Finally, she developed a right chronic subdural hematoma. Conclusion: In patients undergoing neurosurgical procedures, discontinuation of DOACs should be individualized based on neurosurgical bleeding risk and patient renal function. Restarting of DOACs could be considered after at least 48 h when hemostasis has been achieved. Bridging of DOACs cannot be recommended.
- Subjects
INTRACRANIAL hemorrhage; ORAL medication; VENOUS thrombosis; INTRACRANIAL aneurysms; SUBDURAL hematoma; SUBARACHNOID hemorrhage; FRONTAL lobe
- Publication
Surgical Neurology International, 2022, Vol 13, p1
- ISSN
2229-5097
- Publication type
Article
- DOI
10.25259/SNI_1223_2021