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Updated: Aug 6, 2025
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Published on: November 8, 2024
Outcome of Chronic Subdural Hematoma Intervention in Patients on Long-Term Antiplatelet Therapy-A Propensity Score
Mira Salih1, Michael Young1, Alfonso Garcia1
1Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston , Massachusetts , USA.
Insights
For patients with chronic subdural hematomas (cSDH), continuing antiplatelet medications before surgery and resuming them after does not increase complication or rebleeding risks. This finding simplifies surgical decisions for these patients.
Area of Science:
- Neurosurgery
- Neurology
- Internal Medicine
Background:
- Chronic subdural hematomas (cSDH) present management challenges, particularly in patients on antiplatelet therapy.
- Surgical intervention is common for cSDH, but antiplatelet use complicates decision-making regarding pre- and post-procedural management.
Purpose of the Study:
- To evaluate the risks associated with preprocedural and postprocedural antiplatelet medication use in patients undergoing surgical treatment for cSDH.
Main Methods:
- A retrospective analysis of patients with cSDH treated surgically between 2006 and 2022.
- Propensity score matching was used to compare outcomes between patients on antiplatelet medication and those not, analyzing hospitalization length, complications, and reintervention rates.
Main Results:
- No significant differences were observed in hospitalization length, procedural complications, or same-admission reintervention rates between groups.
- Postintervention, resuming antiplatelet medication did not significantly increase recurrence or reintervention rates after discharge.
Conclusions:
- Preintervention antiplatelet use does not negatively impact outcomes for cSDH surgery.
- Resuming antiplatelet therapy post-cSDH intervention is safe and does not elevate rebleeding or reintervention risks.
Background:
Patients presenting with chronic subdural hematomas (cSDHs) and on antiplatelet medications for various medical conditions often complicate surgical decision making.
Objective:
To evaluate risks of preprocedural and postprocedural antiplatelet use in patients with cSDHs.
Methods:
Patients with cSDH who were treated between January 2006 and February 2022 at a single institution with surgical intervention were identified. A propensity score matching analysis was then performed analyzing length of hospitalization, periprocedural complications, reintervention rate, rebleeding risk, and reintervention rates.
Results:
Preintervention, 178 patients were on long-term antiplatelet medication and 298 were not on any form of antiplatelet. Sixty matched pairs were included in the propensity score analysis. Postintervention, 88 patients were resumed on antiplatelet medication, whereas 388 patients did not have resumption of antiplatelets. Fifty-five pairs of matched patients were included in the postintervention propensity score analysis. No significant differences were found in length of hospitalization (7.8 ± 4.2 vs 6.8 ± 5.4, P = .25), procedural complications (3.3% vs 6.7%, P = .68), or reintervention during the same admission (3.3% vs 5%, P = 1). No significant differences were seen in recurrence rate (9.1% vs 10.9%, P = 1) or reintervention rate after discharge (7.3% vs 9.1%, P = 1) in the postintervention group.
Conclusion:
Preintervention antiplatelet medications before cSDH treatment do not affect length of hospitalization, periprocedural complications, or reintervention. Resumption of antiplatelet medication after cSDH procedures does not increase the rebleeding risk or reintervention rate.
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