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Emergency surgery is an effective way to improve the outcome of severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy

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Abstract

The necessity of emergency surgery for severe spontaneous intracerebral hemorrhage (SSICH) patients on long-term oral antiplatelet therapy (LOAPT) remains unclear. The aim of this study was to investigate the effect and safety of emergency surgery for SSICH patients on LOAPT (SSICH-LOAPT patients). In this study, a retrospective review of patients admitted to our institution for SSICH from January 2012 to December 2018 was conducted. The collected data included demographic, clinical, and surgical information. The outcome was recorded at 3 months after primary hemorrhage. The outcome of SSICH-LOAPT patients receiving emergency surgery and conservative treatment were compared. The risk of postoperative intracranial bleeding (PIB) in operated SSICH-LOAPT patients was further investigated. A total of 522 SSICH patients were retrospectively reviewed, including 181 SSICH-LOAPT patients and 269 operated patients. The total mortality and in-hospital mortality were 40.6% and 19.3%, respectively. As compared with SSICH-LOAPT patients receiving conservative treatment, the operated SSICH-LOAPT patients showed a lower total (p = 0.043) and in-hospital mortality (p = 0.024). When compared with operated patients not on LOAPT, the operated patients on LOAPT exhibited a higher rate of PIB (OR, 2.34; 95% CI 1.14–4.79; p = 0.018). As demonstrated by the multivariate logistic analysis, dual antiplatelet therapy were independent risk factors associated with PIB in operated SSICH-LOAPT patients (OR, 3.42; CI, 1.01–11.51; p = 0.047). Despite of increasing risk of PIB, emergency surgery could improve the outcome of SSICH-LOAPT patients as it could be effective in reducing mortality. Dual antiplatelet therapy was the independent risk factor related to the PIB in operated SSICH-LOAPT patients.

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Funding

This study was supported by the “Major special projects in the 13th five-year plan” (Grant No. 2016YFC1301800) and “Key Project of Beijing Municipal Science & Technology Commission” (Grant No. D161100003816006).

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Author notes

  1. Jun Wu, Qingyuan Liu and Kaiwen Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China

    Jun Wu, Qingyuan Liu, Kaiwen Wang, Junhua Yang, Pengjun Jiang, Maogui Li, Yong Cao & Shuo Wang

  2. China National Clinical Research Center for Neurological Diseases, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China

    Jun Wu, Qingyuan Liu, Kaiwen Wang, Junhua Yang, Pengjun Jiang, Maogui Li, Yong Cao & Shuo Wang

  3. Department of Blood Transfusion, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China

    Nuochuan Wang & Yanan Zhang

  4. Department of Neurosurgery, University of South Florida, Tampa, FL, USA

    Zeguang Ren

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  1. Jun Wu
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Contributions

Author contributions to the study and manuscript preparation include the following. Conception and design: JW and QL. Acquisition of data: QL, KW, NW, and ML. Analysis and interpretation of data: QL and PJ. Drafting of the article: JW and QL. Critical revision of the article: ZR and SW. Review of submitted version of manuscript: all authors. Approval of the final version of the manuscript on behalf of all authors: SW. Administrative/technical/material support: ZR, YC, and YZ. Study supervision: SW.

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Correspondence to Yanan Zhang or Shuo Wang.

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ESM 1

Four typical cases of patients with/without postoperative bleeding complication (PIB). (A) No PIB was found in the postoperative CT; (B) Despite remaining partial hematoma (red arrow), no PIB was found postoperatively; (C) A rehemorrhage within the operative region after surgery. (D) A new intracerebral hemorrhage associated with the operation was found twenty-four hours after surgery (yellow region). (JPG 1706 kb)

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Wu, J., Liu, Q., Wang, K. et al. Emergency surgery is an effective way to improve the outcome of severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy. Neurosurg Rev 44, 1205–1216 (2021). https://doi.org/10.1007/s10143-020-01319-x

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