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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Antiplatelet and Anticoagulation Use and Outcomes Following Chronic Subdural Hematoma Drainage: Systematic Review and
Eva Liu1, Natalie Tilbury1, Tye Morin1
1Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Canada.
Insights
Anticoagulation therapy significantly increases the risk of hematoma recurrence and hemorrhage after chronic subdural hematoma evacuation. Both anticoagulation and antiplatelet agents raise the risk of perioperative thromboembolic complications.
Area of Science:
- Neurosurgery
- Thrombosis and Hemostasis
Background:
- Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition.
- Many CSDH patients use antiplatelet (AP) or anticoagulation (AC) therapy preoperatively.
- The impact of these therapies on CSDH evacuation outcomes remains unclear.
Purpose of the Study:
- To investigate the association between preoperative AP or AC therapy and outcomes following CSDH evacuation.
- To assess the risks of recurrence, hemorrhage, and thromboembolic events in patients on AP or AC therapy.
Main Methods:
- A comprehensive literature search was performed across MEDLINE, Embase, and PubMed databases.
- Studies published up to February 2025 focusing on preoperative AP/AC use and CSDH evacuation outcomes were included.
- Data from 47 studies involving 16,288 patients were analyzed.
Main Results:
- Anticoagulation (AC) use significantly increased hematoma recurrence (RR 1.42) and acute postoperative hemorrhage (RR 2.50).
- Antiplatelet (AP) use showed a trend towards increased recurrence and hemorrhage, though less pronounced.
- Both AP and AC significantly elevated the risk of perioperative thromboembolic complications (RR 2.98 and 3.04, respectively).
Conclusions:
- Clinicians must carefully balance the risks of hemorrhage against thromboembolic events when managing antithrombotic therapy for CSDH patients.
- Preoperative anticoagulation poses a significant risk for adverse outcomes after CSDH evacuation.
Introduction:
Chronic subdural hematoma (CSDH) is a common neurosurgical condition. A significant percentage of CSDH patients are on antiplatelet or anticoagulation therapy at baseline. Despite this, the impact of preoperative antiplatelet and anticoagulation therapy on outcomes following CSDH evacuation, specifically the risk of recurrence and thromboembolic events, remain unclear.
Methods:
A search was conducted in MEDLINE (1946 to February 6, 2025), Embase (1974 to February 6, 2025), and PubMed (up to February 7, 2025) on preoperative use of antiplatelet (AP) or anticoagulation (AC) therapy and outcomes following surgical evacuation of CSDH.
Results:
Our literature search identified 3227 studies, out of which 47 were included. There were 16,288 patients included for analysis. Most patients (77%) in the AP group are on aspirin, and most patients in the AC (76%) group are on warfarin. AC use is associated with a significantly increased risk of hematoma recurrence (risk ratio [RR] 1.42, P = 0.002) and acute postoperative hemorrhage (RR 2.50, P = 0.002). AP use was also associated with increased recurrence (RR = 1.141, P = 0.22) and acute hemorrhage (RR 1.45, P = 0.23) though the effects were more modest and uncertain. Both AP (RR 2.98, P = 0.002) and AC (RR 3.04, P = 0.0007) had significantly higher thromboembolic complications in the perioperative period. Mortality was not significantly different, though it approached significance (P = 0.08) for the AC group.
Conclusion:
Clinicians need to weigh the risk of hemorrhage against thromboembolism when deciding when managing antithrombotic therapy for patients undergoing evacuation of CSDH.
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