Recurrence Rate Of Subdural Hematoma Research Articles

Influence of antithrombotic agents on recurrence rate and clinical outcome in patients operated for chronic subdural hematoma

IntroductionChronic subdural hematoma (cSDH) is a common pathology encountered in neurosurgical practice, especially in elderly patients, who frequently require antithrombotic agents. The aim of this study was to investigate the influence of antithrombotic agents on recurrence rates and clinical outcomes in patients operated for cSDH. MethodsA cohort of patients operated for cSDH at one center during a 5 years period was analyzed retrospectively. Presenting symptoms, coagulation testing, history of antithrombotic agents and comorbidities were obtained from the patient charts. The standard neurosurgical procedure was a single burr hole under local anesthesia with insertion of a subdural drainage. Questionnaires and telephone interviews were used to assess the clinical outcome using the modified Rankin Scale (mRS). Good outcome was defined as mRS 0 to 3 and poor outcome as mRS 4 to 6. Results201 patients with cSDH underwent initial surgical treatment and were enrolled in the study. The median follow-up was 81 weeks. 41 patients (20.4%) were on antiplatelet drug and 43 (21.4%) were on phenprocoumon. A recurrent hematoma required surgery in 37 patients (18.4%). A poor outcome was seen in 36 patients (17.9%). Each of older age and administration of phenprocoumon at admission was an independent risk factor predictive of poor outcome, (p=0.001 and p=0.031, respectively)) Administration of antithrombotic agents had no impact on hematoma recurrence. ConclusionAdministration of phenprocoumon and older age might increase the risk of poor outcome in patients with cSDH. Neither the administration of phenprocoumon nor antiplatelet drug influenced the recurrence rate of subdural hematoma in our patient cohort.

Influence of antithrombotic agents on recurrence rate and clinical outcome in patients operated for chronic subdural hematoma.

Chronic subdural hematoma (cSDH) is a common pathology encountered in neurosurgical practice, especially in elderly patients, who frequently require antithrombotic agents. The aim of this study was to investigate the influence of antithrombotic agents on recurrence rates and clinical outcomes in patients operated for cSDH. A cohort of patients operated for cSDH at one center during a 5 years period was analyzed retrospectively. Presenting symptoms, coagulation testing, history of antithrombotic agents and comorbidities were obtained from the patient charts. The standard neurosurgical procedure was a single burr hole under local anesthesia with insertion of a subdural drainage. Questionnaires and telephone interviews were used to assess the clinical outcome using the modified Rankin Scale (mRS). Good outcome was defined as mRS 0 to 3 and poor outcome as mRS 4 to 6. 201 patients with cSDH underwent initial surgical treatment and were enrolled in the study. The median follow-up was 81 weeks. 41 patients (20.4%) were on antiplatelet drug and 43 (21.4%) were on phenprocoumon. A recurrent hematoma required surgery in 37 patients (18.4%). A poor outcome was seen in 36 patients (17.9%). Each of older age and administration of phenprocoumon at admission was an independent risk factor predictive of poor outcome, (p=0.001 and p=0.031, respectively)) Administration of antithrombotic agents had no impact on hematoma recurrence. Administration of phenprocoumon and older age might increase the risk of poor outcome in patients with cSDH. Neither the administration of phenprocoumon nor antiplatelet drug influenced the recurrence rate of subdural hematoma in our patient cohort.

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

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.

Single versus double burr hole drainage of chronic subdural hematomas. A study of 267 cases

A spectrum of surgical techniques has been used in the management of chronic subdural hematomas. Single burr hole and double burr hole drainage are among the commonest techniques. A retrospective analysis of 267 patients with chronic subdural hematomas treated surgically by either single or double burr holes was performed. Recurrence rates of subdural hematomas treated either with single or double burr holes were not significantly different (χ 2; p > 0.05). Thus, the number of burr holes does not affect the post-operative recurrence rate of chronic subdural hematomas. Both techniques are equally effective treatments.