Abstract
ObjectiveTo establish the risk of recurrence in patients with chronic subdural hematoma (cSDH) on antithrombotic treatment (AT, i.e., antiplatelets and anticoagulants). Secondary end points were perioperative morbidity and mortality between groups (AT vs. no-AT group) and exploration if timing of resumption of AT treatment (i.e., prophylactic early vs. late resumption) influenced the occurrence of thromboembolism and hematoma recurrence.MaterialsIn a population-based consecutive cohort, we conducted a retrospective review of 763 patients undergoing primary burr hole procedures for cSDH between January 1, 2005, and December 31, 2010, at the Karolinska University Hospital, Stockholm, Sweden. Early AT resumption was ≤30 days and late >30 days after the procedure.ResultsA total of 308/763 (40.4%) cSDH patients were on AT treatment at the time of diagnosis. There was no difference in cSDH recurrence within 3 months (11.0% vs. 12.0%, p = 0.69) nor was there any difference in perioperative mortality (4.0% vs. 2.0%, p = 0.16) between those using AT compared to those who were not. However, perioperative morbidity was more common in the AT group compared to no-AT group (10.7% vs. 5.1%, p = 0.003). Comparing early vs. late AT resumption, there was no difference with respect to recurrence (7.0% vs. 13.9%, p = 0.08), but more thromboembolism in the late AT resumption group (2.0% vs. 7.0%, p < 0.01).ConclusionIn clinical practice, cSDH patients on AT therapy at the time of diagnosis have similar recurrence rates and mortality compared to those without AT therapy, but with higher morbidity. Early resumption was not associated with more recurrence, but with lower thromboembolic frequency. Early AT resumption seems favorable, and a prospective RCT is needed.
Highlights
Chronic subdural hematoma is a common neurosurgical condition, with increasing incidence rates among the elderly [1, 2, 6, 7, 13, 16, 25, 34]
A total of 308/763 (40.4%) Chronic subdural hematoma (cSDH) patients were on AT treatment at the time of diagnosis
There was no difference in cSDH recurrence within 3 months (11.0% vs. 12.0%, p = 0.69) nor was there any difference in perioperative mortality (4.0% vs. 2.0%, p = 0.16) between those using AT compared to those who were not
Summary
Chronic subdural hematoma (cSDH) is a common neurosurgical condition, with increasing incidence rates among the elderly [1, 2, 6, 7, 13, 16, 25, 34]. In this segment of the population, comorbid conditions are common, and many use antithrombotic medication, that is, antiplatelet and anticoagulant treatment [18]. Due to the comorbidity in this patient population, balancing thromboembolic events against the risk of both acute hemorrhage and recurrence. The risk of thromboembolism when withholding AT therapy is still heavily debated and unsettled [12, 17, 19, 32, 35], adding to the difficulties in the management of this patient category
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