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Chronic Subdural Hematoma.

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    Area of Science:

    • Neurosurgery
    • Geriatrics
    • Pharmacology

    Background:

    • Chronic subdural hematoma (cSDH) primarily affects the elderly.
    • Neurosurgical evacuation is standard for significant hematomas.
    • Current guidelines lack clear recommendations for managing antithrombotic therapy in cSDH patients.

    Purpose of the Study:

    • To review existing literature on antithrombotic management in cSDH.
    • To present findings from a cohort study on cSDH surgery patients.
    • To inform clinical decision-making regarding antithrombotic therapy continuation or discontinuation.

    Main Methods:

    • Systematic literature search (Jan 2015-Oct 2020) in PubMed and EMBASE.
    • Retrospective cohort study of 395 patients undergoing cSDH surgery (Oct 2014-Dec 2019).
    • Analysis of outcomes related to antithrombotic drug management.

    Main Results:

    • Literature findings on thromboembolic risks are heterogeneous.
    • Four of seven comparative studies showed significant differences in thromboembolic risk based on antithrombotic use/discontinuation.
    • In the cohort study, 9.1% of patients experienced thrombotic complications after antithrombotic discontinuation.

    Conclusions:

    • Antithrombotic management in cSDH patients must be individualized.
    • Early reinitiation of antithrombotics or surgery under continued therapy should be considered for high-risk patients.