SDH with Bleeding Diathesis-a Management Protocol

Area of Science:

• Neurosurgery
• Hematology

Background:

• Chronic subdural hematoma (SDH) is a significant cause of morbidity and mortality in the elderly.
• Patients on antiplatelet or anticoagulant therapy face increased perioperative bleeding risks during SDH surgery.

Purpose of the Study:

• To evaluate the efficacy of precise blood product dosing and surgical techniques in preventing hemorrhagic complications in elderly patients with SDH on antiplatelet and/or anticoagulant medications.

Main Methods:

• A retrospective study of 25 elderly patients on antiplatelet and/or oral anticoagulants undergoing emergency SDH surgery between January 2010 and December 2012.
• Patients were categorized into three groups based on medication: antiplatelets only, oral anticoagulants only, or both.
• Interventions included minicraniotomy with microsurgical membranectomy or burr hole craniostomy, with administration of random donor platelet concentrate (RDPC) and/or fresh frozen plasma (FFP) based on medication use.

Main Results:

• No intraoperative bleeding complications or postoperative rebleeding occurred in any of the 25 patients.
• Patients on antiplatelets received a mean of 7 units of RDPC; those on oral anticoagulants received a mean of 4 units of FFP; and those on both received a mean of 7 units of RDPC and 4 units of FFP.
• All patients experienced successful intraoperative hemostasis and favorable postoperative outcomes regarding bleeding.

Conclusions:

• A specific protocol for blood product administration (RDPC for antiplatelets, FFP for anticoagulants) combined with tailored surgical approaches effectively prevents perioperative bleeding in SDH patients on antithrombotic therapy.
• This strategy ensures safe surgical management and reduces the risk of rebleeding in this high-risk patient population.