Hummel Björn Alexander, Senger Sebastian, Schleicher Christian, Eichler Hermann
Institut für Klinische Hämostaseologie und Transfusionsmedizin Universitätsklinikum des Saarlandes Homburg.
Klinik für Neurochirurgie Universitätsklinikum des Saarlandes Homburg.
Dtsch Med Wochenschr. 2018 Jul;113(13):961-964. doi: 10.1055/a-0620-7459. Epub 2018 Jul 4.
82-year old male patient suspected of having cerebral hemorrhage under anticoagulation therapy with Dabigatran due to atrial fibrillation.
CT scan showed bilateral chronic subdural hematomas with fresh blood in left-subdural hematoma and midline shift. Laboratory analysis shows only a moderately high Dabigatran level but thrombin time was high out of range.
Fall-related intracerebral haemorrhage and subdural hematoma under anticoagulation therapy.
Neurosurgical hematoma evacuation and trepanation after preoperative use of Idarucizumab as an antidote for Dabigatran to stop anticoagulative effects and secure normal bleeding conditions, led to reduced midline shift. We started heparin-based anticoagulation first followed by Dabigatran again in clinical steady state and after rehabilitation with neurologically low-grade residuals.
一名82岁男性患者，因心房颤动接受达比加群抗凝治疗，疑似脑出血。
CT扫描显示双侧慢性硬膜下血肿，左侧硬膜下血肿内有新鲜血液且中线移位。实验室分析显示达比加群水平仅中度升高，但凝血酶时间超出正常范围。
抗凝治疗期间因跌倒导致的脑出血和硬膜下血肿。
术前使用依达赛珠单抗作为达比加群的解毒剂以停止抗凝作用并确保正常出血情况，随后进行神经外科血肿清除和开颅手术，中线移位减轻。我们首先开始基于肝素的抗凝治疗，待临床情况稳定且神经功能残留较轻并康复后，再次使用达比加群。
