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Semin Thromb Hemost 1999; 25(1): 73-77
DOI: 10.1055/s-2007-996427
Copyright © 1999 by Thieme Medical Publishers, Inc.

Phenprocoumon from a Neurosurgical Perspective

Gerd Sandvoss* , Wolfhard Erdlenbruch† , Boris Krischek†
  • From the *Neurosugical Department, Ludmillenstift Hospital, Meppen, Germany and
  • †Department of Clinical Hemostaseology and Transfusion Medicine, University Clinics, Homburg, Saar, Germany.
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Publication History

Publication Date:
06 February 2008 (online)

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Abstract

A 9-year series of 45 intracranial and spinal hematomas in patients under oral anticoagulant treatment with phenprocoumon was analyzed and compared to data from the literature. In 42% of the patients, International Normalized Ratio (INR) values >4.5 were found on admission, 36% were older than 70 years and most patients (38%) were under long-term treatment after cardiac valve replacement. Patients who recovered did not report to have given informed consent at the start of anticoagulant therapy. Because an average of five serious hemorrhages are reported/year from German neurosurgical departments, it can be estimated that about 650 intracerebral or intraspinal hematomas, including about 250 fatalities/year occur in Germany under oral anticoagulant treatment. These complications reach the same incidence than spontaneous hematomas either from aneurysms or angiomas. Standards for indications, clinical control, quality INR testing and INR targets not exceeding 4.0, and collecting more data on incidences and causative factors of complications may be an important contribution to reduce these fatalities.

Keywords:

Phenprocoumon - adverse events - anticoagulation - hemorrhage - intracerebral bleeding - intraspinal bleeding - fatal bleeding - self-management