1146. Mortality after Intracranial Hemorrhage in Patients with Hematological Malignancies: A Systematic Literature Review
Authors: Alankrita Raghavan; Kelsey Jensen, BS; Patrick Malloy; James Wright, MD; Christina Wright, MD (Cleveland Heights, OH)
Introduction: Intracranial hemorrhages (ICH) are common pathologies treated in neurosurgical practice. Coagulopathies can have a significant impact on the frequency and severity of bleeds, as well as on surgical decision-making and outcomes for patients. Patients with hematologic disorders are particularly prone to intracranial hemorrhages and potentially to worse surgical outcomes after decompressive surgery. We performed a systematic literature review to determine mortality rates and examine factors associated with increased mortality in this population. Methods: We examined original articles reporting on mortality following ICH in patients with hematological malignancies. PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) were followed. Articles were selected by the following PubMed search terms: (“intracranial hemorrhage” OR “intracerebral hemorrhage” OR “cerebral hemorrhage” OR “subdural hematoma” OR “intraparenchymal hemorrhage) AND (“hematologic neoplasm” OR “myeloproliferative disorders” OR “myelofibrosis” OR “essential thrombocythemia” OR “leukemia”). References of selected articles were screened for additional articles. Articles met inclusion criteria if the abstract was in English and the study reported on mortality after ICH. Results: Fourteen studies met inclusion criteria. These studies reported data on 649 patients with ICHs from 1986-2014. All studies were retrospective. Fifty-two percent were male. The most commonly reported malignancy associated with ICH was acute promyelocytic leukemia. Mean platelet count at the time of ICH was 10.1X10 9 /L (range: 4-48X10 9 /L). Four studies reported on 30-day mortality with a mean of 60% (range: 54%-75%). Median time from hemorrhage to death ranged from 2 days to 1.5 months, with the worst prognosis being associated with acute promyelocytic leukemia. Conclusion: Patients with coincident ICH and hematologic malignancy appear to have increased mortality when compared to those patients without hematologic disorders. Higher level of evidence studies are needed to more accurately elucidate the true survival differences in this patient population.