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Preoperative angiotensin converting enzyme inhibitor usage in patients with chronic subdural hematoma: Associations with initial presentation and clinical outcome.
Journal article

Preoperative angiotensin converting enzyme inhibitor usage in patients with chronic subdural hematoma: Associations with initial presentation and clinical outcome.

  • Neidert MC Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Switzerland. Electronic address: marian.neidert@usz.ch.
  • Schmidt T Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Switzerland.
  • Mitova T Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Switzerland.
  • Fierstra J Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Switzerland.
  • Bellut D Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Switzerland.
  • Regli L Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Switzerland.
  • Burkhardt JK Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Switzerland.
  • Bozinov O Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Switzerland.
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  • 2016-02-23
Published in:
  • Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. - 2016
ACE inhibitor
Angiotensin converting enzyme inhibitors
Bradykinin
Chronic subdural hematoma
Hematoma volume
cSDH
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors
Case-Control Studies
Female
Hematoma, Subdural, Chronic
Humans
Male
Outcome Assessment, Health Care
Recurrence
Retrospective Studies
English The aim of this study is to analyze the association of preoperative usage of angiotensin converting enzyme (ACE) inhibitors with the initial presentation and clinical outcome of patients with chronic subdural hematoma (cSDH). Patients treated for cSDH between 2009 and 2013 at our institution were included in this retrospective case-control study. Medical charts were reviewed retrospectively and data were analyzed using descriptive and inferential statistics. Out of 203 patients (58 females, mean age 73.2years), 53 (26%) patients were on ACE inhibitors before their presentation with cSDH. Median initial hematoma volume in individuals with ACE inhibitors (179.2±standard error of the mean [SEM] 13.0ml) was significantly higher compared to patients without ACE inhibitors (140.4±SEM 6.2ml; p=0.007). There was an increased probability of surgical reintervention in the ACE inhibitor group (12/53, 23% versus 19/153, 12%; p=0.079), especially in patients older than 80years (6/23, 26% versus 3/45, 7%; p=0.026). ACE inhibitors are associated with higher hematoma volume in patients with cSDH and with a higher frequency of recurrences requiring surgery (especially in the very old). We hypothesize that these effects are due to ACE inhibitor induced bradykinin elevation causing increased vascular permeability of the highly vascularized neomembranes in cSDH.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/141734
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