Antiplatelet Medication and Operative Subdural Hematomas: A Retrospective Cohort Study Evaluating Reoperation Rates

Antiplatelet therapy is common and complicates the operative management of subdural hematomas (SDH). The risk of reoperation inferred by antiplatelet medication and the ability of platelet transfusion to reduce hemorrhagic complications in patients presenting with antiplatelet associated SDHs are poorly defined.

We performed a retrospective review of consecutive patients treated with craniotomy or craniectomy for evacuation of an acute or mixed-density SDH between 2012 and 2017 at 2 academic institutions. Exclusion criteria included anticoagulant therapy, thrombocytopenia, and/or international normalized ratio >1.3. Clinical and radiographic data were collected; primary endpoint was reoperation within 30 days. Logistic regression models were used to identify predictors of reoperation.

A total of 195 patients were included: 86 patients on antiplatelet medication and 109 with no antithrombotic history. Overall, 24 (12.3%) of patients required a reoperation. Reoperation rate in patients on antiplatelet medication was not significantly different than those not on antithrombotics (14.0% vs. 11.0%, P = 0.53). Patients taking antiplatelet medication were significantly older, more likely to have medical comorbidities, and more likely to receive preoperative platelet transfusion (36.0% vs. 3.7%, P < 0.001). Of patients taking antiplatelet medications, there was no difference in reoperation rate between those patients receiving preoperative platelet transfusion and those not receiving transfusion (16.1% vs. 12.7%, P = 0.75).

Antiplatelet medication was not a significant predictor of reoperation following evacuation of an acute or mixed-density SDH. In patients on antiplatelet medication, preoperative platelet transfusion did not reduce reoperation rates.