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

Area of Science:

• Neurosurgery
• Geriatrics
• Pharmacology

Background:

• Chronic subdural hematoma (CSDH) is common in the elderly.
• Anticoagulant use is a known risk factor for CSDH.
• The temporal relationship between trauma and symptom onset in CSDH is not fully understood, especially concerning anticoagulants.

Purpose of the Study:

• To investigate the effect of warfarin on the post-traumatic interval in patients with CSDH.
• To determine if warfarin accelerates the clinical manifestation of CSDH after minor head trauma.

Main Methods:

• Retrospective observational study of 126 surgically treated CSDH patients with reliable trauma histories (2016-2022).
• Patients stratified by antithrombotic use: warfarin, aspirin, warfarin plus aspirin, or none.
• Analysis of the post-traumatic interval (time from trauma to neurological symptoms).

Main Results:

• The median post-traumatic interval was significantly shorter in the warfarin group compared to controls and aspirin users.
• Warfarin use was associated with higher rates of bilateral hematomas and cerebral herniation.
• Poorer short-term functional outcomes were observed in the warfarin group, though most improved post-surgery.

Conclusions:

• Warfarin may shorten the latent period of CSDH, potentially through rebleeding or accelerated hematoma remodeling.
• Clinicians should anticipate earlier neurological deterioration in warfarin-treated patients after head trauma.
• Early vigilance and imaging are crucial for anticoagulated elderly patients following even minor head trauma.