Subdural Hematoma: Drug Therapy

Therapeutic targets

• Seizure prevention
• Reduction of intracranial pressure
• Avoidance of secondary diseases and complications
• If necessary, normalization of blood clotting

Therapy recommendations

• Seizure prophylaxis with carbamazepine
• For small hematoma (<10 mm) and mild symptoms:
  • Glucocorticoids → dexamethasone → anti-inflammatory (anti-inflammatory) effect on the neomembrane.
• For hematoma reduction:
  • Antifibrinolytic → tranexamic acid
• Used to normalize blood clotting:
  • Fresh frozen plasma (FFP) – a blood product obtained from human donor blood, which contains the liquid and dissolved components of the blood; the cells of the blood (erythrocytes, leukocytes, platelets) have been largely removed by centrifugation; Caution: it should not be used without a clinically manifest bleeding tendency!
  • Vitamin K
  • Recombinant factor VIIa
• Caveat: As soon as the symptoms worsen under conservative therapy, the skull must be opened! (See under “Surgical Therapy”)
• Low-dose (75-300 mg/day) continuous medication with acetylsalicylic acid (ASA; antiplatelet agent), as prescribed in primary and secondary prevention of vascular events, does not increase the risk of intracranial hemorrhage.