Determinants of outcome in anticoagulation-associated cerebral hematoma requiring emergency evacuation

Objective: To analyze the likelihood of recovery and prognostic factors in patients with massive anticoagulation-associated intracerebral hemorrhage treated with surgical evacuation after reversal of anticoagulation. Design: Retrospective case series. Setting: Neurological-Neurosurgical Intensive Care Unit at Mayo Clinic. Patients: Seventeen consecutive patients with large anticoagulation-associated intracerebral hemorrhage. Intervention: Surgical evacuation of intracerebral hemorrhage. Main Outcome Measure: Functional outcome was assessed using the modified Rankin scale. Results: Before surgery, all patients had pronounced (> 1-cm) shift of the septum pellucidum and one third had clinical signs of uncal herniation. Still, favorable outcome (modified Rankin scale score <= 3) was achieved by 11 patients (65%). All patients with good recovery awoke within 36 hours of surgery. Older age (P=.05) and serious systemic complications after surgery (P <.01) were significantly associated with lack of neurological recovery and fatal outcome. Conclusions: Emergency surgery for select deteriorating patients with large anticoagulation-associated intracerebral hemorrhage is compatible with favorable outcome despite the presence of clinical and radiological signs of herniation before the evacuation.