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Acute Traumatic Subdural Hematoma and Anticoagulation Risk.
Maryam Kia1, Rajeet Singh Saluja1,2, Judith Marcoux1,2
1Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
Summary
Resuming anticoagulation with residual subdural hematoma (SDH) after traumatic brain injury (TBI) significantly increases re-hemorrhage risk. Carefully weigh this risk against the dangers of prolonged anticoagulation cessation.
Area of Science:
- Neurosurgery
- Neurology
- Trauma Care
Background:
- Anticoagulation is crucial for preventing thromboembolic events.
- Standard practice often involves withholding anticoagulation after traumatic brain injury (TBI) with intracranial hemorrhage.
- Limited data exist on optimal anticoagulation resumption timing following TBI, particularly with traumatic subdural hematomas (SDH).
Purpose of the Study:
- To investigate the risks associated with resuming anticoagulation in patients with traumatic subdural hematomas (SDH).
- To determine the incidence of re-hemorrhage and thromboembolic events in relation to anticoagulation status and SDH resolution.
Main Methods:
- A retrospective review of 95 patients with traumatic SDH requiring anticoagulation at a level 1 trauma center.
- Data collected included reasons for anticoagulation, duration of interruption, CT findings, and outcomes such as thromboembolic events and SDH re-hemorrhage.
Main Results:
- Anticoagulation was held for a median of 67 days.
- Most patients (82.1%) resumed anticoagulation after SDH resolution; 17.9% resumed with residual SDH.
- Resuming anticoagulation with residual SDH was linked to a 41.2% re-hemorrhage rate, increasing to 62.5% with large remnants. Only one patient (1.1%) had a thromboembolic event while anticoagulation was held.
Conclusions:
- Resuming anticoagulation in the presence of residual traumatic subdural hematoma (SDH) poses a significant risk of re-hemorrhage.
- This risk must be carefully balanced against the potential complications of extended anticoagulation interruption.
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