Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Nov;159(11):2045-2052.
doi: 10.1007/s00701-017-3330-x. Epub 2017 Sep 27.

Role of antithrombotic therapy in the risk of hematoma recurrence and thromboembolism after chronic subdural hematoma evacuation: a population-based consecutive cohort study

Ida Fornebo  1 , Kristin Sjåvik  2 , Mark Alibeck  3 , Helena Kristiansson  3 , Fredrik Ståhl  3 , Petter Förander  3 , Asgeir Store Jakola  4   5   6 , Jiri Bartek Jr  7   8
Affiliations

Role of antithrombotic therapy in the risk of hematoma recurrence and thromboembolism after chronic subdural hematoma evacuation: a population-based consecutive cohort study

Ida Fornebo et al. Acta Neurochir (Wien). 2017 Nov.

Abstract

Objective: To establish the risk of recurrence in patients with chronic subdural hematoma (cSDH) on antithrombotic treatment (AT, i.e., antiplatelets and anticoagulants). Secondary end points were perioperative morbidity and mortality between groups (AT vs. no-AT group) and exploration if timing of resumption of AT treatment (i.e., prophylactic early vs. late resumption) influenced the occurrence of thromboembolism and hematoma recurrence.

Materials: In a population-based consecutive cohort, we conducted a retrospective review of 763 patients undergoing primary burr hole procedures for cSDH between January 1, 2005, and December 31, 2010, at the Karolinska University Hospital, Stockholm, Sweden. Early AT resumption was ≤30 days and late >30 days after the procedure.

Results: A total of 308/763 (40.4%) cSDH patients were on AT treatment at the time of diagnosis. There was no difference in cSDH recurrence within 3 months (11.0% vs. 12.0%, p = 0.69) nor was there any difference in perioperative mortality (4.0% vs. 2.0%, p = 0.16) between those using AT compared to those who were not. However, perioperative morbidity was more common in the AT group compared to no-AT group (10.7% vs. 5.1%, p = 0.003). Comparing early vs. late AT resumption, there was no difference with respect to recurrence (7.0% vs. 13.9%, p = 0.08), but more thromboembolism in the late AT resumption group (2.0% vs. 7.0%, p < 0.01).

Conclusion: In clinical practice, cSDH patients on AT therapy at the time of diagnosis have similar recurrence rates and mortality compared to those without AT therapy, but with higher morbidity. Early resumption was not associated with more recurrence, but with lower thromboembolic frequency. Early AT resumption seems favorable, and a prospective RCT is needed.

Keywords: Anticoagulants; Antiplatelet; Antithrombotics; Chronic subdural hematoma; Neurosurgery; Recurrence; Thromboembolism; Treatment outcomes.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical considerations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK. Chronic subdural haematoma in the elderly. Postgrad Med J. 2002;78:71–75. doi: 10.1136/pmj.78.916.71. - DOI - PMC - PubMed
    1. Asghar M, Adhiyaman V, Greenway MW, Bhowmick BK, Bates A. Chronic subdural haematoma in the elderly—a North Wales experience. J R Soc Med. 2002;95:290–292. doi: 10.1258/jrsm.95.6.290. - DOI - PMC - PubMed
    1. Aspegren OP, Astrand R, Lundgren MI, Romner B. Anticoagulation therapy a risk factor for the development of chronic subdural hematoma. Clin Neurol Neurosurg. 2013;115:981–984. doi: 10.1016/j.clineuro.2012.10.008. - DOI - PubMed
    1. Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev. 2004;27:263–266. doi: 10.1007/s10143-004-0337-6. - DOI - PubMed
    1. Baraniskin A, Steffens C, Harders A, Schmiegel W, Schroers R, Spangenberg P. Impact of pre-hospital antithrombotic medication on the outcome of chronic and acute subdural hematoma. J Neurol Surg A Cent Eur Neurosurg. 2014;75:31–36. doi: 10.1055/s-0032-1325629. - DOI - PubMed

LinkOut - more resources