Neurologic complications caused by anticoagulants and fibrinolytic agents

We examined 126 patients, of whom 54 had suffered brain hemorrhage, 33 subdural hematoma, 18 subarachnoid bleeding, nine spinal hemorrhage and twelve hematoma with peripheral deficits. Neurologic disorders were seen in patients subject to therapy with coumarins 2-4 years after initiating therapy, whereas hemorrhages under heparine and streptokinase regimes were observed after only a few days. Clotting values were below a therapeutic range in only some of the cases. A clinical diagnosis should be verified by CT scanning. Blood clotting normally recovers after discontinuation of anticoagulation or fibrinolysis. Surgery will improve the prognosis in many cases of subdural hematoma or spinal hemorrhage; conservative treatment in cases of intracerebral, subarachnoid, and peripheral hemorrhage. A 70-percent lethality was recorded for patients suffering a cerebral hemorrhage. More than a third of patients with subarachnoid bleeding and less than a third of cases with subdural hematoma died. While peripheral lesions tended to improve, spinal hemorrhage often resulted in irreversible paraplegia. By respecting contra-indications for anticoagulation therapy and limiting the duration of such regimes the risk of hemorrhage within the CNS and other nerve structures may be reduced. Interactions with other drugs precipitating clotting disorders should also be taken into account.