Abstract
In an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.
Highlights
Chronic subdural hematomas are among the most common neurosurgical conditions that predominately affect elderly patients [14]
This study examined the clinical outcome (GOS, modified Rankin Scale (mRS)) of 151 Chronic subdural hematomas (cSDH) patients on anticoagulants and 159 cSDH patients on antiplatelets after surgical hematoma removal and compared findings to a cohort of cSDH patients without such antithrombotic medication
Our current data show that patients on antithrombotics have no significantly higher risk of reoperation due to residual hematomas or rebleeding compared to patients without antithrombotics in multivariate analysis (Fig. 4)
Summary
Chronic subdural hematomas (cSDH) are among the most common neurosurgical conditions that predominately affect elderly patients [14]. Commonly mild in its early symptoms, cSDH might turn into a severe disease with high recurrence and complication rates reaching 29%, resulting in increased mortality [32, 44]. In an aging society of industrialized countries, the incidence of this disease is expected to double in the 20 years, becoming the Alexander Younsi and Lennart Riemann contributed to this work. Despite these upcoming challenges, several aspects of the clinical management of cSDH, predictors for its recurrence, and the role of antithrombotics on recurrence rates and clinical outcome are still unclear.
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