Perioperative Discontinuation of Antiplatelet and Anticoagulation Therapy in Chronic Subdural Hematoma: Impact on...

The purpose of this study was to evaluate the effect of perioperative discontinuation of antiplatelet and anticoagulation therapy (AAT) on in-hospital mortality, functional outcome, and recurrence in patients with chronic subdural hematoma (CSDH) with prior AAT use, compared to patients without AAT. We retrospectively analyzed data from patients with symptomatic CSDH who underwent surgery in our department between June 2012 and December 2023. Prior AAT was discontinued at hospital admission and reinitiated 3 weeks postoperatively if CSDH resolution was complete. Clinical and neurological status at admission and discharge were assessed using the modified Rankin Scale, with scores >3 defined as a poor outcome. Among 852 surgically treated CSDH patients (mean age 75.2 years; female-to-male ratio 1:2.1), univariate analysis revealed that prior AAT use was significantly associated with higher in-hospital mortality (p = 0.043) and poor functional outcome (p < 0.001), but not with recurrence (p = 0.434). However, multivariate analysis demonstrated that prior AAT use was not an independent predictor of mortality (p = 0.099) or poor outcome (p = 0.956). Notably, patients with prior (acetylsalicylic acid) aspirin use exhibited significantly lower recurrence rates compared to patients without AAT (p = 0.012) and to the general cohort (p = 0.003). The multivariate analysis showed that prior aspirin use was an independent predictor of reduced recurrence rates (p = 0.015, adjusted odds ratio = 0.504; 95% confidence interval 0.290-0.877). This large-scale study supports the safety of perioperative AAT discontinuation in CSDH patients, showing no significant differences in in-hospital mortality, functional outcome, or recurrence compared to patients without AAT. Intriguingly, prior aspirin therapy was associated with reduced recurrence, suggesting a potential protective role.