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Anticoagulant and antiplatelet use in seniors with chronic subdural hematoma: Systematic review

Santhosh Nathan1, Zahra Goodarzi1, Nathalie Jette1

  • 1From the Cumming School of Medicine (S.N.), Departments of Medicine (Z.G., J.H.-L.), Community Health Sciences (N.J., J.H.-L.), and Clinical Neurosciences (N.J., C.G.), Hotchkiss Brain Institute (N.J., C.G., J.H.-L.), and O'Brien Institute for Public Health (N.J., J.H.-L.), University of Calgary, Canada.

Neurology
|April 16, 2017
PubMed

Insights

Restarting anticoagulants in older adults with chronic subdural hematoma (cSDH) may increase rebleeding risk. Antiplatelet agents, however, showed no significant association with rebleeding in this patient group.

Area of Science:

  • Neurology
  • Geriatrics
  • Pharmacology

Background:

  • Chronic subdural hematoma (cSDH) is a significant concern in older adults.
  • Management decisions regarding anticoagulants and antiplatelet agents in cSDH patients are complex.
  • Previous reviews have addressed this topic, necessitating an updated analysis.

Purpose of the Study:

  • To evaluate the risks associated with restarting anticoagulants or antiplatelet agents in older patients with cSDH.
  • To provide evidence-based guidance for clinical decision-making in this vulnerable population.

Main Methods:

  • An updated systematic review was conducted, searching major databases from January 2012 to December 2016.
  • Included studies focused on older adults (over 65 years) with cSDH who were on anticoagulant or antiplatelet therapy.
  • Seven studies were identified and analyzed for relevant outcomes.

Main Results:

  • Anticoagulant use was associated with an increased risk of cSDH rebleeding in two studies.
  • Antiplatelet medication use did not demonstrate a significant association with cSDH rebleeding.
  • Optimal timing for resuming these medications post-cSDH remained unclear.

Conclusions:

  • Anticoagulant therapy in older adults with cSDH is linked to a higher risk of rebleeding.
  • Antiplatelet therapy does not appear to increase the risk of rebleeding in this context.
  • Further research is needed to clarify the safe resumption of these medications.
Abstract

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