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Published on: October 15, 2021
Impact of antithrombotic therapy on surgical treatment in patients with chronic subdural hematoma
Toshiyuki Amano1, Satoshi Matsuo1, Yuichiro Miyamatsu1
1Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Insights
Resuming antithrombotic therapy around 3 days after chronic subdural hematoma (CSDH) surgery minimizes complications. Multiple agents increase recurrence risk, and early recurrence predicts reoperation.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Critical Care Medicine
Background:
- Antithrombotic therapy use in chronic subdural hematoma (CSDH) patients is debated.
- Understanding its impact on surgical outcomes is crucial.
Purpose of the Study:
- To investigate the association between antithrombotic therapy and surgical complications and outcomes in CSDH patients.
Main Methods:
- Retrospective analysis of 323 CSDH patients undergoing single burr-hole craniostomy.
- Evaluation of preoperative antithrombotic use, complications, recurrence, and reoperation rates.
Main Results:
- 108 patients (33%) received preoperative antithrombotic therapy.
- Hemorrhagic and thromboembolic complications occurred in 6 and 8 patients, peaking at 3 and 4.5 days post-surgery.
- CSDH recurrence was observed in 62 cases, requiring reoperation in 16. Discontinuing antiplatelet therapy for >2 weeks correlated with thromboembolic complications (p=0.005). Postoperative multiple antithrombotic agents were linked to CSDH recurrence (p=0.03). Early recurrence (<2 weeks) predicted reoperation (p=0.006).
Conclusions:
- Optimal timing for antithrombotic resumption is ~3 days post-CSDH surgery to reduce morbidity.
- Postoperative use of multiple antithrombotic agents increases CSDH recurrence risk.
- Early CSDH recurrence (<2 weeks) is a predictor for subsequent reoperation.
Objective:
The effects of antithrombotic therapy on chronic subdural hematoma (CSDH) are controversial. Herein, we investigated the association of antithrombotic therapy with surgical complications and outcomes in patients with CSDH.
Methods:
We retrospectively analyzed 323 consecutive patients with CSDH who underwent single burr-hole craniostomy.
Results:
One hundred and eight patients (33%) underwent preoperative antithrombotic therapy. Hemorrhagic and thromboembolic complications were detected in 6 and 8 patients, respectively, which peaked at 3 and 4.5 days after CSDH surgery, respectively. CSDH recurrence was detected in 62 cases, and reoperation was required in 16 cases. Discontinuance of antiplatelet therapy for >2 weeks was significantly associated with thromboembolic complications (43%; p = 0.005). Postoperative use of multiple antithrombotic agents was significantly associated with CSDH recurrence (40%; p = 0.03). Further, earlier recurrence within 2 weeks was significantly associated with the following reoperation (62%; p = 0.006).
Conclusions:
To reduce morbidity and minimize the risk of CSDH reoperation, the optimal timing for resumption of antithrombotic agents is approximately 3 days after CSDH surgery. Postoperative use of multiple antithrombotic agents can increase CSDH recurrence, while earlier recurrence may be a predictor for the following reoperation.
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