Abstract P554: Effect of Antithrombotic Medications on MMA Embolization for Chronic Sub Dural Hematoma a Case Control Study

Abstract

Background: Chronic subdural hematoma (CSDH) is a serious problem with an incidence of 20.6 per 100000 in North America and is predicted to grow with aging population and Antithrombotic use. MMA embolization is a therapy for treatment of CSDH, which in retrospective studies has been shown to be effective. It is unclear when and if the antithrombotic medications could be resumed in the setting of CSDH. Hypothesis: Among patients with CSDH who undergo MMA embolization outcomes are no different in patients who resume the antithrombotic (AT) medications Methods: We did a retrospective review of all cases of MMA embolization done over last 2.5 years in 2 tertiary care centers. Comparison of cases (antithrombotic resumption) vs controls in which antithrombotic medications were stopped. A successful outcome was defined as reduction of at least 50% volume in CSDH. Univariate analysis regarding all outcome measures for baseline variables using Fisher exact test or t-test. Multivariate logistic regression with favorable and unfavorable outcomes as dependent variables controlling for age and surgical evacuation of the hematoma. Results: There were a total of 57 MMA embolization cases, 33 of them had no AT started after surgery and 23 of them had AT resumption at a mean of 2.4 days. Almost equal number of patients had AC (12 pt’s) and AP (11 pt’s) resumed. About 40% of patients had surgical evacuation done prior to MMA embolization and there was significant reduction in volume of CSDH on follow up imaging as shown in fig. The significant difference between the patients who had AT resumption vs others, was that these patients had more often CAD (71% vs 21% p= 0.001) and Afib (58% vs 18% p=0.002) necessitating the renewal of AT. There was no significant difference in hematoma reduction or volume even after adjusting for surgical evacuation (OR 1.0039 95% CI 0 .60- 1.67). Conclusions: There is no significant difference in CSDH volume reduction in patients who have AT resumption after MMA embolization.