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Influence of antiplatelet therapy on postoperative recurrence of chronic subdural hematoma: a multicenter
Masanori Wada1, Iwao Yamakami2, Yoshinori Higuchi3
1Department of Neurosurgery, Chiba Rehabilitation Center, 1-45-2 Hondacho, Midori-ku, Chiba-shi, Chiba 266-0005, Japan.
Insights
Antiplatelet agents (APA) significantly increase the risk of chronic subdural hematoma (CSH) recurrence after surgery. Stopping APA before surgery reduces this risk, with the effect diminishing over time.
Area of Science:
- Neurosurgery
- Hematology
- Pharmacology
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition.
- Recurrence of CSDH can lead to significant morbidity.
- The role of antiplatelet agents (APA) in CSDH recurrence is not fully understood.
Purpose of the Study:
- To investigate whether antiplatelet agents (APA) increase the risk of chronic subdural hematoma (CSDH) recurrence.
- To determine the impact of APA on CSDH recurrence rates after surgical intervention.
Main Methods:
- A multicenter, retrospective, observational study involving 719 patients undergoing burr-hole craniostomy and irrigation for CSDH.
- Analysis of risk factors for CSDH recurrence, with a specific focus on APA use.
Main Results:
- Preoperative oral APA administration was significantly associated with increased CSDH recurrence (32% vs 11%).
- The odds ratio for recurrence in APA users was 3.77.
- The risk of recurrence decreased as the time between APA discontinuation and surgery increased.
Conclusions:
- Antiplatelet therapy is a significant risk factor for CSDH recurrence.
- Discontinuation of APA prior to surgery may reduce recurrence rates.
- Further research into optimal management of APA in CSDH patients is warranted.
Objective:
The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect.
Method:
We examined risk factors for CSDH recurrence, focusing on APA, in 719 consecutive patients who admitted to three tertiary hospitals and underwent burr-hole craniostomy and irrigation for CSDH. This was a multicenter, retrospective, observational study.
Results:
Age, sex, history of diabetes mellitus, hypertension, chronic renal failure, alcohol consumption habits, consciousness disturbance on admission, or preoperative CT density was not associated with recurrence. Subdural drainage was significantly associated with less recurrence. Preoperative oral APA administration was significantly associated with more recurrence. The recurrence rate of CSDH in non-APA group was 11% if surgery was performed on admission. However, if surgery was performed immediately after discontinuation of oral APA administration, the recurrence rate in APA group significantly increased to 32% (p value<0.0001; odds ratio, 3.77; 95% confidence interval, 1.72-8.28). The effect of APA on CSDH recurrence gradually diminished as the number of days until initial surgery, after stopping APA, increased.
Conclusion:
Antiplatelet therapy significantly influences the recurrence of CSDH.
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