Warfarin-associated Chronic Subdural Hematomas May Exhibit a Shorter Post-traumatic Interval: An Observational Study

Chronic subdural hematoma remains one of the most common neurosurgical conditions in elderly patients, with anticoagulant use recognized as a major risk factor. This retrospective observational study investigated whether warfarin influences the temporal relationship between minor head trauma and the onset of neurological symptoms, here defined as the post-traumatic interval. Among 373 surgically treated patients between 2016 and 2022, only 126 with reliable trauma histories were included to minimize recall bias. Patients were stratified according to antithrombotic use (warfarin, aspirin, warfarin plus aspirin, or none). The median the post-traumatic interval was significantly shorter in the warfarin group compared with controls and aspirin users, suggesting that anticoagulation accelerates clinical manifestation. Warfarin was also associated with higher rates of bilateral hematomas, cerebral herniation, and poorer short-term functional outcomes, although most patients improved after surgical evacuation. The strict inclusion process reduced the sample size but increased the validity of the post-traumatic interval assessment, and the concept of the post-traumatic interval itself is not yet a validated clinical parameter. These findings raise the hypothesis that warfarin may shorten the latent period of chronic subdural hematoma through mechanisms of rebleeding and accelerated hematoma remodeling. Recognition of this effect could help clinicians anticipate earlier neurological deterioration in anticoagulated patients, underscoring the importance of early vigilance and imaging after seemingly trivial trauma in this high-risk population.