Prognostic factors and analysis of mortality due to brain haemorrhages associated with vitamin K antagonist oral anticoagulants. Results from the TAC Registry

Dear Editor:

The article by Zapata-Wainberg et al.¹ called my attention as it makes no reference as to whether surgical treatment was used in any case. Our understanding of this condition may have improved if the benefits of surgery had been analysed. A contemporary article by Fernández-Sanz et al.² explicitly mentions that surgically treated patients were excluded.

Since the STICH study, we have questioned the usefulness of surgery for spontaneous haematomas and especially for haematomas associated with coagulation disorders. According to the clinical practice guidelines in intracerebral haemorrhage published by the Spanish Society of Neurology,³ the benefits of surgery do not outweigh the procedure's potential for harm in most cases; the guidelines provide several recommendations for surgical treatment. However, in daily clinical practice, we are often consulted about the possibility of surgical treatment that, in our opinion as experts, will be futile, even though it is difficult at times to contain the enthusiasm for treatment. In the meantime, we must acknowledge that retrospective studies such as the article in question do provide information, which is generally already known. However, there is a need for further prospective studies to establish, for example, the cases in which surgery would improve outcomes, in terms of both mortality and morbidity. Therefore, it is essential that future prospective studies include the participation of the specialties involved in this treatment: neurology, neurosurgery, neuroradiology, anaesthesiology, intensive care, etc. Despite the existence of many cerebrovascular disease registries, where the main concern of the authors often seems to be to find an attractive name, it may be more productive to focus on improving clinical history and using the minimum basic dataset (MBDS) to expand our knowledge of haemorrhagic strokes. The study by Hernández-Medrano et al.⁴ reports that the quality of the MBDS for cerebrovascular diseases guarantees the collection of valid information and that the registry of hospital discharges may be a useful tool for performing studies on this condition. The most useful parameters for determining whether a healthcare system is efficient are the destination at discharge and hospitalisation duration.