Reinitiating anticoagulation in chronic subdural hematomas: does adding middle meningeal artery embolization add...

Area of Science:

• Neurosurgery
• Vascular Interventional Neurology
• Clinical Outcomes Research

Background:

• The safety of early anticoagulation in chronic subdural hematoma (cSDH) patients undergoing surgery, with or without middle meningeal artery embolization (MMAE), is not well-established.
• This study investigates the impact of early anticoagulation on 6-month outcomes in cSDH patients treated surgically, with or without MMAE.

Purpose of the Study:

• To evaluate the safety and efficacy of early anticoagulation in cSDH patients treated with surgery plus MMAE.
• To compare outcomes between anticoagulated cSDH patients treated with surgery alone versus surgery plus MMAE.

Main Methods:

• Retrospective analysis of cSDH patients (aged ≥18) on the TriNetX platform using ICD-10 and RXNORM codes.
• Two cohorts were analyzed: surgery plus MMAE stratified by anticoagulation use, and anticoagulated patients stratified by surgical approach (alone vs. plus MMAE).
• Primary outcomes included repeat surgery and 6-month mortality; secondary outcomes included repeat intracranial hemorrhage and cerebral infarction.

Main Results:

• In the surgery plus MMAE cohort (n=801), early anticoagulation (n=143) showed no significant difference in repeat surgery or 6-month mortality compared to non-anticoagulated patients (n=658).
• Anticoagulated patients receiving surgery plus MMAE (n=143) had significantly lower 6-month mortality (7.9% vs. 19.4%) and reduced repeat intracranial hemorrhage (54.0% vs. 66.9%) compared to those undergoing surgery alone (n=2301).

Conclusions:

• Early anticoagulation following surgery with adjunct MMAE is safe for cSDH patients.
• This combined approach is associated with reduced mortality and hemorrhage risk in anticoagulated patients compared to surgery alone.