Subdural Hematoma: Therapy

General measures

• Nicotine restriction (refraining from tobacco use).
• Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
• Review of permanent medication due topossible effect on the existing disease.
  • Anticoagulants
    • Coumarins (phenprocoumon* (product names: Marcumar, Falithrom); warfarin (product names: Coumadin, Marevan); acenocoumarol (product name: Sintrom).
    • Direct inhibitors of thrombin (Argatroban, Lepirudin).
    • Heparin analogues (fondaparinux).
    • Heparins (certoparin, dalteparin, enoxaparin, nadroparin, reviparin, tinzaparin).
    • Heparinoids (danaparoid
    • New oral anticoagulants (NOAK; NOAC; direct oral anticoagulants, DOAK).
      • Direct factor Xa inhibitor (apixaban, edoxaban, rivaroxaban).
      • Direct and selective factor Xa inhibitor (apixaban).
      • Selective thrombin inhibitor (dabigatran); antidote: idarucizumab can reverse the effect of the oral anticoagulant dabigatran within minutes; bleeding stops within 2.5 hours-but there may be a rebound in bleeding times after 12 to 24 hours, leading to rebleeding in some patients.
    • Antiplatelet agents (abciximab, acetylsalicylic acid (ASA), combination of acetylsalicylic acid and dipyridamole, clopidogrel, eptifibatide, ilomedin (prostacyclin analog), prasugrel, ticagrelor, ticlopidine, tirofiban)Low-dose (up to 300 mg/day) continuous medication with acetylsalicylic acid (ASA; Antiplatelet agents), as prescribed in the primary and secondary prevention of vascular events, does not increase the risk of intracranial hemorrhage.
  • Fibrinolytics (drugs used for the acute treatment of conditions caused by vascular occlusion; they cause the blood clot to dissolve).

Rehabilitation

• Physiotherapy
• Speech therapy
• Occupational therapy