765 Outcome of Chronic Subdural Hematoma Management in Patients on Long Term Antiplatelet Therapy—A Propensity Score Matched Analysis

Abstract

INTRODUCTION: Chronic subdural hematomas (cSDH) are particularly common in frail older adults given their increased risk of falls, and the fact that they often have conditions that require antithrombotic agents, such as antiplatelets. METHODS: Patients who underwent surgical management for subdural hematoma (SDH) at our institution between January 2006 and June 2021 were identified. Propensity score matched analysis was used to make a balance in patients on antiplatelets before procedure vs those who were not on antiplatelets and patients on antiplatelets post-procedure vs those who were not. Length of hospitalization, peri-procedural complications, reintervention rate during the same admission, rebleeding risk and reintervention rates after discharge were compared. RESULTS: In total, 180 patients were on long-term antiplatelets before procedure, while 286 were not. After matching, 57 pairs were included in analysis. Post-procedure, 76 patients were started on long-term antiplatelets, the rest were not. Then 44 patients in each group were included in the analysis after matching. Comparing the pre-procedure antiplatelet group with non-antiplatelet group, no significant differences were found in length of hospitalization (7.9 ± 5.5 vs 9.2 ± 7.7, p = 0.28), procedural complications (3.5% vs 5.3%, p = 0.65), or reintervention during the same admission (10.5% vs 3.5%, p=0.14). In the comparison of post-procedure antiplatelet group and non-antiplatelet group, no significant differences were seen in recurrence rate (9.1% vs 13.6%, p = 0.5) or reintervention rate after discharge (4.5% vs 4.5%, p = 1). CONCLUSIONS: Being on long-term antiplatelets before cSDH procedures does not affect length of hospitalization, peri-procedural complications or reintervention during the same admission. Similarly, long-term antiplatelets after cSDH procedure does not increase rebleeding risk or reintervention rate. Our data suggest that similar management protocols can be applied to both groups of patients, and it is safe to restart antiplatelet agents in the setting of a chronic subdural hematoma (cSDH).