Does Early Resumption of Low-Dose Aspirin after Evacuation of Chronic Subdural Hematoma with Burr-Hole Trepanation Lead to Higher Recurrence Rates?

Abstract

Aim: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases typically affecting elderly people. Many of these patients present with other comorbidities like coronary artery disease (CAD) and receive antiplatelet therapy with acetylsalicylic acid (ASA). Despite growing clinical relevance, there is still a lack of data focusing on the perioperative management of such patients. The aim of this study was to investigate the association between timing of postoperative antiplatelet resumption and the recurrence rates of cSDH. Methods: A total of 140 (18.7%) out of 750 consecutive patients undergoing surgical evacuation of cSDH under antiplatelet therapy with low-dose ASA were included in this study. In addition to the baseline characteristics, patients' files were retrospectively reviewed for recurrence rate, clinical outcome, morbidity, and mortality. Using a multivariate logistic regression model, the correlation between timing of postoperative ASA resumption and recurrence rate was analyzed. The primary end point was postoperative recurrence rate of subdural hematomas requiring revision surgery. The secondary end points were major cardiovascular events, morbidity, and mortality. Results: Multivariate logistic regression analysis showed no statistical significant association between early postoperative resumption of ASA treatment and recurrence of cSDH (OR 0.99; CI: 0.978–0.999; p > 0.5). The corresponding OR of experiencing a recurrence when resuming ASA therapy one day earlier was 1.01. High postoperative mRS (OR 1.59; CI 1.14–2.23; p = 0.006) and low postoperative GCS score (OR 0.78; CI: 0.6–1.01; p = 0.041) were statistically significant risk factors for recurrence of cSDH. Postoperative myocardial infarction (3 cases vs. 1 case), other thrombotic events (6 vs. 0 cases), surgical morbidity (19 cases vs. 1 case), and mortality (4 cases vs. 1 case) showed no significant difference between patients with discontinued ASA therapy and those under continuous ASA treatment. Conclusion: Our data suggest that in patients undergoing burr-hole trepanation for cSDH, the early resumption of low-dose ASA therapy is not associated with higher recurrence rates. We therefore recommend early resumption of ASA therapy, especially in patients treated for secondary prevention of CAD.