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Safe Burr Hole Surgery for Chronic Subdural Hematoma Using Dabigatran with Idarucizumab
- Source :
- World Neurosurgery. 109:432-435
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background Chronic subdural hematoma (CSDH) is a common intracranial hematoma. The number of patients who undergo anticoagulant therapy including a direct oral anticoagulant (DOAC) is expected to increase. Recently, idarucizumab, the antidote for dabigatran, which is a DOAC, has been developed. We successfully treated CSDH with dabigatran using emergency burr hole surgery and idarucizumab. Case Description A 79-year-old Japanese man severely hit his head and visited the emergency department. Computed tomography (CT) showed tiny traumatic acute subdural hematoma, for which he was admitted. At that time, atrial fibrillation was newly detected, for which dabigatran, having a specific antidote (idarucizumab), was chosen and started 2 weeks after the discharge. Two months after the trauma episode, he revisited the emergency department because of acute left upper and lower limb motor weakness. CT revealed a midline shifted CSDH. Considering rush course of motor weakness and shifted brain, we performed emergency surgery using an antidote for dabigatran, idarucizumab. He was discharged 5 days after surgery without any complications or excessive perioperative hemorrhage. Conclusion Dabigatran should be used for atrial fibrillation detected after head trauma. Emergency surgery can be safely performed for CSDH with dabigatran using idarucizumab.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Intracranial hematoma
Antidotes
030204 cardiovascular system & hematology
Antibodies, Monoclonal, Humanized
Head trauma
Dabigatran
03 medical and health sciences
0302 clinical medicine
Atrial Fibrillation
Trephining
medicine
Humans
Antidote
Aged
business.industry
Atrial fibrillation
Idarucizumab
Emergency department
Perioperative
medicine.disease
Surgery
Hematoma, Subdural, Chronic
Anesthesia
Neurology (clinical)
Emergencies
Tomography, X-Ray Computed
business
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 18788750
- Volume :
- 109
- Database :
- OpenAIRE
- Journal :
- World Neurosurgery
- Accession number :
- edsair.doi.dedup.....f464143829e248dddbfd75d9c165f3f4