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Management of subdural haematoma: a practical guide
Rebecca Hutchins1, Nuria Horner1, David Shipway1
1Geriatric Trauma Service, NHS North Bristol NHS Trust, Bristol, UK.
Practical Neurology
|June 16, 2026
Summary
Acute and chronic subdural hematomas require careful management, especially in older patients on antithrombotic medication. Decisions on restarting these medications balance bleeding risks against clotting risks.
Area of Science:
- Neurosurgery
- Geriatrics
- Vascular Medicine
Background:
- Subdural hematomas (acute and chronic) are common and carry significant mortality.
- Management is complex in older, frail patients, often with comorbidities like cardiovascular or thrombotic disease.
- Antithrombotic medication use presents challenges in managing these conditions.
Purpose of the Study:
- To review recent advances in the care of acute and chronic subdural hematomas.
- To discuss challenges related to antithrombotic medication in these patients.
- To evaluate the role of middle meningeal artery embolisation for chronic subdural hematoma.
Main Methods:
- Review of current literature and clinical practices regarding subdural hematoma management.
- Analysis of risks and benefits associated with antithrombotic therapy in this population.
- Assessment of the safety and efficacy of middle meningeal artery embolisation.
Main Results:
- Individualized decisions are crucial for restarting antithrombotic agents, balancing thrombosis and hemorrhage risks.
- Middle meningeal artery embolisation is emerging as a safe and effective treatment for chronic subdural hematoma.
- Advances in care are improving outcomes for older, frail patients with subdural hematomas.
Conclusions:
- Care for subdural hematomas, particularly in elderly patients on antithrombotics, requires nuanced risk-benefit assessment.
- Middle meningeal artery embolisation shows promise as a therapeutic option for chronic subdural hematoma.
- Continued research and evolving evidence will shape future management strategies.
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