Nii Kouhei, Eto Ayumu, Hiraoka Fumihiro, Tsutsumi Masanori
Department of Neurosurgery, Fukuoka University Chikushi Hospital.
No Shinkei Geka. 2018 Nov;46(11):983-988. doi: 10.11477/mf.1436203852.
A 93-year-old woman incurred a head bruise 5 days prior to presentation, and head CT revealed right subacute subdural hematoma. As she was on direct oral anti-coagulant(DOAC)treatment for non-valvular atrial fibrillation(NVAF), the DOAC administration was stopped temporarily to prevent an increase in the size of the hematoma. Dabigatran treatment was initiated after the confirmation of no change in hematoma size and the follow-up CT revealed a reduction in the hematoma. However, left upper limb paresis occurred on day 12 of dabigatran treatment and head CT revealed the onset of right chronic subdural hematoma. Emergency burr hole surgery was performed after intravenous administration of idarucizumab to neutralize the dabigatran. Her neurologic symptoms improved after the operation and no recurrence of subdural hematoma was observed even after dabigatran treatment was resumed. Dabigatran could be administered relatively safely, even for subacute intracranial hemorrhage complicated with NVAF, suggesting the possibility of the prevention of ischemic stroke. Moreover, even when intracranial hemorrhage recurred, the prompt neutralizing effect of idarucizumab, a dabigatran-specific neutralizing agent, was useful in the surgical intervention and perioperative management.
一名93岁女性在就诊前5天头部擦伤，头部CT显示右侧亚急性硬膜下血肿。由于她正在接受非瓣膜性心房颤动（NVAF）的直接口服抗凝剂（DOAC）治疗，为防止血肿增大，暂时停用了DOAC。在确认血肿大小无变化且后续CT显示血肿缩小后，开始使用达比加群治疗。然而，在达比加群治疗第12天时出现左上肢轻瘫，头部CT显示右侧慢性硬膜下血肿形成。静脉注射艾达司珠单抗以中和达比加群后，进行了紧急钻孔手术。术后她的神经症状改善，即使恢复达比加群治疗后也未观察到硬膜下血肿复发。即使对于合并NVAF的亚急性颅内出血，达比加群也可相对安全地给药，提示预防缺血性卒中的可能性。此外，即使颅内出血复发，达比加群特异性中和剂艾达司珠单抗的快速中和作用在手术干预和围手术期管理中也很有用。
